Journal of public health dentistry最新文献

Objectives

To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil.

Methods

This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing.

Results

Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome.

Conclusions

In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice.

Objective

Individuals with disabilities face elevated risks of adverse oral health outcomes compared with the general population, including worse periodontal health, increased edentulism, and untreated dental decay. Given the varied impacts of different disabilities on people's health and well-being, this study aims to investigate diverse associations between untreated decay and cognitive, physical, emotional, and sensory disabilities among US adults.

Methods

This cross-sectional study analyzed questionnaire and clinical examination data on 7084 adults (≥20 years) from the 2015–18 National Health and Nutrition Examination Survey cycles. Sociodemographics, oral health behaviors, health conditions, and disability were all examined. The prevalence of tooth decay was calculated as the proportion of adults with untreated decay. Survey-weighted multivariable logistic regression was used to assess associations between disability and untreated decay.

Results

In general, untreated decay was more than twice as prevalent in individuals with three or more disabilities as in those without any disabilities (34.5% vs. 13.2%, p < 0.001). After adjusting for confounders, lack of functional dentition was the most significant predictor of untreated decay prevalence (adjusted odds ratio: 2.97, 95% CI: 2.37–3.72). Other significant factors were younger age (20–44), non-Hispanic black race or ethnicity, low-income status, having an underlying chronic condition, not having a past-year dental visit, symptomatic dental visits, and current tobacco use.

Conclusion

No associations were found between disability type (cognitive, emotional, physical, and sensory) and untreated decay among community-dwelling US adults. Several health-related, social, and behavioral factors emerged as primary predictors of untreated decay. Further research is needed to explore disability types and dental caries determinants.

Objectives

To assess the relationships between longitudinal fluoride intakes and bone densitometry outcomes in young adults.

Methods

Data were analyzed from the Iowa Fluoride Study and Iowa Bone Development Study, which followed 1,882 infants from birth in 1992. Daily fluoride intakes were assessed using detailed questionnaires sent every 1.5–6 months, and multi-row detector computed tomography (MDCT) scans of distal tibia were obtained from 330 participants aged 23 years. Sex-specific bivariate and multivariable associations with MDCT outcomes were examined using linear regression. Because of the multiple statistical analyses being conducted, p-values < 0.01 were considered statistically significant.

Results

In fully adjusted analyses, no statistically significant (p < 0.01) or suggestive (0.01 < p < 0.05) associations were found between period-specific or cumulative fluoride intake and bone measures for either sex, although there were suggestive positive relationships in unadjusted analyses.

Conclusions

Longitudinal fluoride intakes had little association with bone measures at age 23. As there were no adverse effects from fluoride intake on bone health in young adults, results support the continued use of fluorides, particularly community water fluoridation is the most cost-effective method of dental caries prevention.

Objectives

This study assesses the needs and feasibility of conducting a produce prescription (produce Rx) program in a pediatric dental clinic setting serving low-income patients.

Methods

We conducted a cross-sectional quantitative survey examining several household characteristics including demographics, benefits received, fruit and vegetable intake patterns, food security, feasibility of a produce Rx program, and respondents' answers to questions based on social cognitive theory constructs. The survey was administered at the University of Nebraska Medical Center (UNMC) pediatric dental clinic, a pediatric dental residency clinical training site. One hundred adult respondents with low income completed a 36-item questionnaire during their child's dental appointment.

Results

Almost half of respondents reported experiencing food insecurity (45%). Respondents who were food insecure experienced higher levels of nutrition insecurity (p = 0.012), less confidence in choosing fruits and vegetables (FVs) (p = 0.026), difficulty in purchasing FVs in their neighborhood (p = 0.012), and more concern that FVs cost too much (p < 0.001) when compared to respondents who were food secure. Notwithstanding the barriers they face, almost all respondents reported that they eat FVs because of health benefits (95%) and to set a good example for their family (91%). Additionally, most respondents expressed an interest in produce Rx programs (80%) and nutrition education activities (81%).

Conclusions

This study demonstrated the potential for produce Rx program uptake in a pediatric dental clinic setting through positive caregiver-reported need and interest. Future studies should explore how produce Rx programs can be adapted most effectively in this novel setting.

Objectives

Early Childhood Caries is a global health problem. The Bright Smiles Bright Futures (BSBF) program seeks to equip educators, children, and parents with skills and knowledge about oral health promotion habits early in life. The aim of this study was to examine parental perceptions of the BSBF program and identify key facilitators and barriers for its implementation.

Methods

Twelve mothers of children who participated in the BSBF program in five Early Childhood Education and Care (ECEC) settings in NSW, Australia were recruited in this qualitative study. Data were collected via focus groups and interviews, transcribed verbatim and coded to categorize for inductive thematic analysis.

Results

Five major themes emerged: Promoters of the BSBF oral health program, barriers to the BSBF oral health program implementation and participation, online resources, impact of the BSBF oral health program, and strategies for enhancing the BSBF oral health program. While participants reported that the program encouraged their children's toothbrushing, they found issues with the program's materials, ECEC center attendance, and communication about the oral health program with their children. The program improved message retention, attitudes, routines, and family perceptions toward oral health. Participants recommended oral health literacy, changed delivery formats, increased dental access, and inclusion of interactive elements to enhance the program.

Conclusions

The findings from this study provide insight to improve parents' experiences and engagement in oral health promotion. This can help to raise awareness of the importance of child oral health among policymakers, healthcare professionals, and the public to inform public health policy discussions.

Objective

Alaska Native children may be at increased risk for dental caries because of added sugar intake from sugar-sweetened fruit drinks. This study describes development of a questionnaire to (a) assess Alaska Native caregivers' beliefs, knowledge, and behaviors regarding sugar-sweetened fruit drinks, and (b) describe behavior changes within a community-based intervention.

Methods

Questionnaire development was conducted in three phases with Yup'ik Alaska Native caregivers in Southwest Alaska: (1) initial selection and adaptation of questionnaire items; (2) cognitive testing; and (3) data collection. The Sugar-Sweetened Fruit Drink Questionnaire (SFDQ) contains 31 culturally-tailored items across six areas: beliefs/values, environment/skills, knowledge, motivation, self-efficacy, and behaviors.

Results

Eighty-one percent of caregivers gave their children sugar-sweetened fruit drinks. Motivations included: what they grew up with (52%), few other options (46%), makes child happy (46%), healthier than soda (45%), and others in community drink them (42%). On average, 93% of caregivers believed drinking a lot of sugar-sweetened fruit drinks leads to cavities in children and caregivers agreed (mean 4.1 on 5-point scale, 5 = strongly agree) it is important to limit sugar-sweetened fruit drinks. Among a sub-sample of respondents (n = 20), we found low to moderate temporal stability in some SFDQ items over a 10–14 day period, indicating respondent ambivalence and/or uncertainty.

Conclusions

Using community-based participatory research methods, we developed a culturally tailored exploratory questionnaire that will be used to describe changes in caregiver knowledge, beliefs, attitudes, self-efficacy, and behavior within a planned intervention to reduce sugar-sweetened fruit drink intake in Alaska Native children.

Objectives

To examine variations in the delivery of teledentistry after the COVID-19 pandemic and to explore oral health professionals' utilization of various teledentistry modes of delivery.

Methods

In this mixed methods case study, we collected teledentistry claims data from patient electronic health records (n = 78,756) encompassing various types of teledentistry utilization in clinical settings and through community outreach from a Dental Support Organization (DSO) in Oregon from January 2021 to November 2022. We analyzed the patient demographic and claims data using descriptive statistics and logistic regression analyses to identify patterns of teledentistry service delivery. Qualitatively, we conducted virtual interviews (n = 13) through Microsoft Teams with oral health professionals about their experiences with teledentistry utilization. We used inductive and deductive coding to code individual transcripts and identify common themes among provider experiences.

Results

Out of the 78,756 electronic health record claims for teledentistry, 75.7% used synchronous audio, 13.4% used synchronous video, and 10.9% used asynchronous teledentistry methods. We observed a 8.6% increase in synchronous audio teledentistry utilization at the end of the study period, compared with a 4.2% increase in synchronous video and a 4.4% decrease in asynchronous teledentistry. Oral health professionals interviewed reported choosing the type of teledentistry delivery based on patient and provider access to the virtual teledentistry platform.

Conclusion

Oral health professionals' knowledge of and experiences with teledentistry need to be considered when developing policy and best practices for the use of teledentistry for patient care.

Objectives

We aimed to evaluate the association between antibiotic prophylaxis and adverse outcomes following tooth extraction within the Veterans Affairs Healthcare System.

Methods

We conducted a retrospective cohort study of patients undergoing dental extractions in 2015–2019. The primary exposure was antibiotic prophylaxis. The primary outcome was post-extraction complication within 7 days (e.g., alveolar osteitis and surgical site infection); the secondary outcome was subsequent medical care relating to a post-extraction oral complication within 7 days. Multivariable logistic regression models assessed the independent effect of antibiotic prophylaxis on each outcome.

Results

Of 385,880 visits with a dental extraction, 122,810 (31.8%) received antibiotic prophylaxis. Overall, 3387 (0.9%) experienced a post-extraction complication and 350 (0.09%) received medical care relating to a post-extraction oral complication within 7 days. In multivariable regression, diabetes was a statistically significant (p = 0.01) effect modifier of the association between antibiotic prophylaxis and post-extraction complication. Among visits for patients without diabetes, antibiotic prophylaxis was significantly associated with an increased odds of post-extraction complication (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.13–1.38), but among visits for patients with diabetes no significant effect was observed (OR = 1.03, 95% CI: 0.92–1.15). Antibiotic prophylaxis was not significantly associated with post-extraction medical care (OR = 1.04; 95% CI: 0.83–1.30).

Conclusions

In this large retrospective cohort, we observed no significant protective effect of antibiotic prophylaxis on post-extraction complications or subsequent medical care utilization in a setting with low complication rates. These data suggest that use of antibiotic prophylaxis in similar settings may need to be re-evaluated to minimize unnecessary antibiotic use.

Objectives

To (1) assess perceptions of parents of patients ages 9–17 years regarding human papillomavirus (HPV) vaccine counseling and a same-day HPV vaccine program, and (2) assess perceptions among dental staff who actively participated in the same administration program.

Methods

We conducted a post-evaluation, convenience survey of parents of patients aged 9–17 and dental staff at a large-urban federally qualified healthcare center (FQHC) from July 25, 2022, to August 26, 2022. Parent and staff perceptions were assessed using validated instruments whenever possible. Data were analyzed descriptively.

Results

Overall, 101 parents participated (response rate: 89%). Overall, 80 parents (74.3%) reported wanting to discuss diseases prevented by the HPV vaccine with their dental provider. Twenty parents (20%) reported receiving counseling on the HPV vaccine by their dentist; 95% (n = 19) of those parents reported it did not change their comfort with their provider and 60% (n = 12) reported their child received the vaccine that day.

Overall, 44 dental staff members (32% DDS/DMD, 14% RDH-BS-Dental Hygiene, 55% Other) completed surveys (response rate: 100%). Of these, 39 (88.6%) were willing to recommend the HPV vaccine and participate in a referral program. Nearly all dentists and hygienists (95%) reported discussing the vaccine was within their scope of practice, and most (65%) agreed vaccine administration should be within their scope.

Conclusion

In a single site convenience survey within an urban, federally qualified health care system, most parents, and dental staff perceived HPV vaccine counseling and administration favorably and clinically appropriate during routine dental visits.

Objectives

To determine the feasibility of a medical dental integration program to provide overdue vaccinations to adolescents ages 9–17 and evaluate the facilitators and barriers to the process.

Methods

The program was developed and implemented at one dental clinic co-located within a medical clinic at a federally qualified healthcare center in Denver, Colorado. Utilizing a shared electronic health record, human papillomavirus, meningococcal, and/or tetanus-diphtheria-acellular pertussis vaccines were recommended by dental providers and then administered by the medical team. Plan-do-study-act cycles informed implementation. Descriptive analyses of eligible patients were performed and run charts were used track process implementation outcomes.

Results

One hundred and sixty eligible adolescents were identified during a 6-month period. Overall, 29 patients (18%) received 41 vaccines. Process facilitators included staff buy-in and individual provider feedback and barriers included staff shortages and family vaccine refusal/preference to receive vaccines in the medical home.

Conclusions

Many adolescents see dental providers more than their primary care providers, creating an opportunity to vaccinate adolescents overdue for immunizations during dental visits. A medical dental integration program to provide adolescent vaccinations was feasible in a federally qualified health center with co-located medical and dental services. Expansion to diverse healthcare settings is necessary to further explore implementation outcomes.