JDR Clinical & Translational Research最新文献

Introduction: There are minimal evidence-based outcomes from clinical trials for medical-dental integration. This formative work and pilot study is a precursor to a larger cluster-randomized clinical trial in adult primary care practices to test an electronic health record (EHR) structured workflow for primary care providers (physicians/nurse practitioners [NPs]) and medical staff (medical assistants [MAs] and nurses) with oral health (OH) screening and referral for Medicaid-enrolled adults ≥55 years.

Methods: This study was conducted in 2 practices with providers, medical staff, and older adults. Focus groups preceded the pilot study to gain stakeholder insights prior to the multilevel interventions of systems changes and provider education. The system-level EHR changes for medical staff included ask (OH screening), advise (visit dentist soon/annually), assess (need for referral: eReferral to co-located dentists or structured referral to community dentists), and connect (referral; resources). Provider education (didactic and skills) was based on the Common-Sense Model of Self-Regulation (CSM) to deliver OH facts to older adults at primary care visits. Descriptive analysis was used to report on process outcomes of reach, adoption, and implementation/fidelity.

Results: After stakeholder input, the CSM-based didactic and skills curriculum was developed, and 4 physicians were trained. Changes in the Epic EHR were implemented, and 19 medical staff were trained in this new structured workflow together with physicians. In terms of reach, 83% (N = 80) of older adults were enrolled out of 96 approached (female: 66%; non-Hispanic: 83%; Caucasian: 43%). Workflow adoption was 100% of MAs completing the EHR questions and 89% of providers documenting giving OH facts. About 94% of older adults reported their physician giving them OH facts indicating implementation/fidelity of the intervention. About 60% of older adults reported no dental visits in the past year, and 66% requested eReferrals.

Conclusion: This study presents an innovative systems-based multilevel intervention for medical-dental integration.

Knowledge transfer statement: The results of this study can be used by practice leadership and clinicians when incorporating oral health into primary care for older adults. Considering adoption and implementation costs, this information could lead to a more complete approach to address oral health with patients.

Introduction: In 2011, the Institute of Medicine (IOM) recommended a minimum of 4 clinical oral health competencies for nondental professionals to promote optimal oral health, including (1) recognizing risk for oral disease through competent oral examinations and (2) making and tracking referrals.

Objectives: We determined whether California school nurses (SNs) knew about specific components of the 2 IOM competencies mentioned above using 3 clinical case scenarios following the Association of State and Territorial Dental Directors Basic Screening Survey Methodology.

Methods: In this cross-sectional study, a 23-item pilot-tested online survey was completed by 358 active California School Nurses Organization members between April and June 2023. We conducted univariate, bivariate, and multivariable linear regression analyses.

Results: For the first scenario, 61% of SNs correctly identified the condition as "root tips," with 93% indicating correctly that such a case should be referred immediately. In the second scenario, almost 77% of SNs correctly identified "untreated tooth decay," with 50% correctly suggesting that a child with untreated tooth decay without dental pain should visit a dental office within several weeks. In the third scenario, almost 50% correctly identified an abscessed tooth, with 75% indicating that a child with this condition should be referred immediately. Multivariable adjusted linear regression analysis showed that SNs with a bachelor's degree or lower had significantly lower overall knowledge in accurately identifying dental conditions and choosing appropriate dental referrals (P = 0.02).

Conclusions: At least half of the participating SNs accurately identified the dental conditions and chose the appropriate dental referrals. The educational status of SNs was a strong predictor of SNs' overall knowledge of identifying oral health conditions and appropriate dental referrals. SNs, when adequately trained, can assess oral health needs and make appropriate dental referrals as part of school-linked dental programs.

Knowledge transfer statement: SNs can identify common dental conditions in children and appropriately refer them to a dental professional. When adequately trained, they can be a valuable resource in implementing school-linked dental programs.

Introduction: Persistent, painful temporomandibular disorders (TMDs) are challenging to manage and usually require the active engagement of patients. To achieve this, it is necessary to understand the complex and multifactorial nature of persistent pain. Many dental professionals have little education about persistent pain and may prefer to offer structural management and advice. This research aims to explore how people understand their persistent TMD and how this understanding has been influenced by their treatment providers.

Methods: Twenty-one people were recruited to represent a diversity of experience with persistent TMD. Interviews followed a semistructured topic guide. Themes were constructed through reflexive thematic analysis to represent how people made sense of their symptoms and the messages that they had picked up through their treatment journey.

Results: Participants described examples of conflicting opinions and inconsistent management recommendations. They rarely recalled collaborative discussions about the nature and complexity of their symptoms and different options for treatment. This experience is represented by a single theme, "a medical merry-go-round." Subthemes of "a medical journey to nowhere-participants' frustrated attempts to find medical management that will end their pain" and "is it me?-participants' questioning their role in persisting pain" kept participants on the merry-go-round, while symptom resolution and participants' emerging development of a holistic understanding of their TMD pain provided exit points. Understanding pain holistically tended to be helpful and typically occurred despite rather than because of the advice given in routine treatment settings.

Conclusion: Participants in this study had not typically found their pain management within dental and medical settings to have helped them to construct meaning and understand their experiences of painful TMD. However, understanding symptoms holistically was experienced as beneficial. This study suggests that improved communication and signposting within services for persistent TMD may be beneficial to patients with TMD pain.

Knowledge transfer statement: Results of this study confirm that being offered a series of anatomically based, singular-cause explanations for persisting pain symptoms had been experienced as unhelpful by the participants who had sought help for their TMD. Participants highlighted the importance of accurate and collaborative communication and of dental professionals explicitly adopting and communicating a biopsychosocial understanding of pain to their patients who have TMD. Results highlight that some people can struggle to manage persisting pain with minimal support. Signposting patients to appropriate services and resources may help them to understand more about the nature of persistent pain and methods of managing it.

Background: "One health" is an integrated, unifying approach that recognizes the interconnectedness between the health of people, animals, and the environment. Oral diseases are the most common diseases to affect humankind, and it is increasingly acknowledged that key determinants of oral heath are social and environmental. However, there is a dearth of information on the relationship between oral health and one health.

Aims: A scoping review was conducted to examine how animal and environmental health affects human oral health and vice versa, to examine the interest in the field overtime, and to provide a synthesis of the literature concerning one health in the oral health context to date.

Methods: A broad standardized search strategy was employed across 5 electronic databases. Screening of publications with defined inclusion and exclusion criteria followed PRISMA-ScR (the Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

Results: The initial search yielded 345 articles; 163 remained after removal of duplicates. Nineteen articles were identified as "potentially effective studies," and after consideration of the full text, 13 articles were identified as "effective studies" to inform this review. Most studies were published since 2020 (60.5%, 8/13), and there were reports from 5 of the 6 World Health Organization regions (except the Eastern Mediterranean region). Most studies were observation in nature and mostly of cross-sectional study design (84.7%, 11/13 studies). More than half of the studies (53.8%, 7/13) were concerned with how environmental factors such as chemical exposures affect human oral health. Studies involving animals (46.2%, 6/13) highlighted the risk of zoonotic infections from horses and livestock to humans.

Conclusions: There is a recent and growing interest in "one health" in the oral health context. Qualitative synthesis of data highlighted the interconnectedness between the health of animals and environment with human health with implications for consideration and action by dentistry.

Knowledge transfer statement: The results of this scoping review address the importance of dentistry in the "one health" concept. This scoping review will allow other researchers to be aware of and fill literature gaps with respect to the impact of animal health and environment on oral health and contribute to future research.

Background: Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries.

Aim: To describe parental perceptions and challenges in dental care utilization for their children with ECC.

Design: A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis.

Results: Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits.

Conclusion: Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC.

Knowledge transfer statement: The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.

Introduction: This study implemented a single-session oral health education and referral program in behavioral health settings serving people with psychiatric disabilities. The program was led by peer specialists ("peers")-lay community behavioral health workers with personal experience of mental health challenges who are trained and certified to support others.

Methods: Investigators collaborated with peers, state government, and clinical leadership to design and implement the program. Randomized parallel assignment was used to compare 2 arms: (1) group viewing of an oral health educational video (VC) and (2) a peer-led 1-time class providing education and motivation to access dental care (the Oral Health Recovery Group; OHRG). In both arms, peers followed up with participants to encourage accessing dental care and reinforce at-home care goals. Oral health knowledge, at-home care, motivation, appointment scheduling, and utilization were assessed at baseline, postintervention, and 2 mo. Qualitative interviews assessed barriers and facilitators.

Results: More than half of participants reported oral pain in the previous year. Pre-/postintervention survey results did not significantly improve in either arm or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC reported meeting a dental at-home care goal because of the program. Ten (27%) in OHRG and 9 (36%) in VC reported making a dental appointment because of the program. Most were satisfied with the program. Interviewed participants were comfortable with peers in this role, yet access barriers remained.

Conclusions: Single-session oral health interventions were implemented in behavioral health settings. The fact that surveys did not significantly improve suggests that more intensive interventions may be needed. Nevertheless, peers successfully scheduled dental appointments for vulnerable patients. Given that dental appointments were scheduled after only a 1-time class and light-touch peer navigation, oral health integration in behavioral health settings shows promise as a financially sustainable approach that merits further research.

Knowledge transfer statement: The results of this study can be used by staff in behavioral health settings who wish to consider peer-led financially sustainable approaches to providing oral health education and linkages to dental care for their clients.

Introduction: The Rocky Mountain Network of Oral Health is 1 of 3 regional projects funded by the Health Resources and Services Administration (2019 to 2024) focusing on caries prevention through medical-dental integration (MDI) in community health centers (CHCs). MDI models included provision of preventive oral health services (POHS) at medical visits by the medical team (model 1), by integrated dental hygienists (DHs; model 2), or a hybrid of these models (model 3). The overarching aim is to evaluate the effectiveness of these models on 3 objectives: (1) ≥50% receive POHS, (2) ≥75% with high caries risk receives dental referral, and (3) ≥30% of parents/caregivers set an oral health goal for the child.

Methods: Primary care association practice facilitators (PFs) recruited 22 CHCs to participate from Arizona, Colorado, Montana, and Wyoming. CHCs completed oral health needs assessments prior to participating. PFs coached CHCs using an MDI change package. CHCs submitted monthly and 6-mo, aggregated, deidentified population metrics for children aged 0 to 40 mo receiving well-child care visits. Monthly CHC-specific reports were used by PFs with teams in continuous quality improvement activities. POHS delivery trends over time were assessed using a linear mixed model, adjusting for number of eligible patients during each 6-mo reporting period.

Results: Participating CHCs were urban (55%), rural (36%), and frontier (8%). Twelve (55%) had co-located dental clinics. Ten CHCs implemented model 1, 5 implemented model 2, and 7 implemented model 3. From September 2020 to August 2023, CHCs reported providing 91,604 POHS to eligible children. After adjustment, there was significant improvement over time for all objectives: objective 1: F(5, 90) = 4.66, P = 0.0008; objective 2: F(5, 90) = 2.99, P = 0.0151; objective 3: F(5, 90) = 4.56, P = 0.0009.

Conclusions: The implementation of 3 MDI models across 22 CHCs in 4 states resulted in a meaningful increase in POHS delivery. POHS delivery by both medical and embedded DHs was associated with the most substantial increase in POHS delivery.

Knowledge transfer statement: The results of this study can be used by medical and dental providers when deciding which approach they wish to use when planning the delivery of preventive oral health services at medical visits.

Objectives: Lower socioeconomic status (SES) is associated with increased dental pain among children. Lower SES in childhood may also contribute to the experience of dental pain among older adults, regardless of the SES in later life. However, this association is still unclear.

Methods: We used cross-sectional data from the 2019 Japan Gerontological Evaluation Study using self-administrated questionnaires to investigate the causal mediating pathways between childhood SES and dental pain in later life using several SES variables collected at older age as potential mediators. A total of 21,212 physically and cognitively independent participants aged 65 y or older were included in the analysis. The dependent variable was experiencing dental pain during the past 6 mo. The independent variable was the SES at the age of 15 y (low/middle/high). Ten covariates were selected covering demographics and other domains. Education, subjective current income, objective current income, objective current property ownership, and the number of remaining teeth were used as mediators. Prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for dental pain by childhood SES were calculated using a modified Poisson regression model.

Results: The mean age of the study participants was 74.5 ± 6.2 y, and 47.5% were men. Of these, 6,222 participants (29.3%) experienced dental pain during the past 6 mo, and 8,537 participants (40.2%) were of low childhood SES. Adjusted for covariates and mediators, the participants with middle and high childhood SES had a lower PR of dental pain (PR = 0.93 [95%, CI 0.89-0.98], PR = 0.79 [95% CI, 0.73-0.85], respectively). Almost 40% of the association between childhood SES and dental pain at older age was mediated via SES in later life and the number of teeth.

Conclusions: This study reemphasizes the importance of support for early-life SES to maintain favorable oral health outcomes at an older age.

Knowledge transfer statement: The results of this study can be used by policymakers to promote policies based on a life-course approach that supports children living in communities with low SES and helps them maintain favorable oral health outcomes into their older age.

Introduction: A public oral health screening, periodontal disease screening, has been implemented in Japan, but it remains unclear whether screening encourages subsequent regular dental visits. This study aimed to examine whether people who underwent periodontal disease screening were more likely to regularly visit dentists after undergoing the screening than before using a difference-in-differences (DID) approach.

Methods: This study used health care claims data of municipality residents who underwent periodontal disease screening in 2017 or 2018. For each screening recipient, 4 individuals were extracted from those who did not undergo screening as controls. In the DID analysis, we assessed the change in the proportion of dentist visits at least once every 180 d after undergoing screening.

Results: A total of 4,050 participants were included in the analysis. The proportion of participants visiting dentists was consistent throughout the study period (approximately 45%) among the participants who did not undergo the screening. However, among the participants who underwent the screening, while the proportion who visited dentists was consistent before screening (approximately 60%), the proportion was higher after screening (1-180 d after, 81.2%). DID analysis indicated that the proportion increased by 12.9% after the screening. In addition, the age-subgroup DID estimates were higher in the younger population (aged 20-35 y, 13.9%; 40-55 y, 12.8%; 60 y, 12.6%).

Conclusions: Among people who underwent periodontal disease screening, a higher proportion visited dentists after undergoing the screening than before, suggesting that periodontal disease screening was associated with an increase in subsequent regular dental visits.

Knowledge transfer statement: Our results provide evidence that a public oral health screening could increase regular dental visits, which has the potential to improve and maintain people's oral health, especially in the younger population.

Knowledge transfer statement: It is evident that some progress in reducing ECC prevalence in children has been made, but these improvements are not equally distributed. Systemic inequities in oral health among the youngest, most vulnerable children must be reduced.