Effective use of longitudinal study data is challenging because of divergences in the construct definitions and measurement approaches over time, between studies and across disciplines. One approach to overcome these challenges is data harmonization. Data harmonization is a practice used to improve variable comparability and reduce heterogeneity across studies. This study describes the process used to evaluate the harmonization potential of oral health-related variables across each survey wave.
National child cohort surveys with similar themes/objectives conducted in the last two decades were selected. The Maelstrom Research Guidelines were followed for harmonization potential evaluation.
Seven nationally representative child cohort surveys were included and questionnaires examined from 50 survey waves. Questionnaires were classified into three domains and fifteen constructs and summarized by age groups. A DataSchema (a list of core variables representing the suitable version of the oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonization status assessments, 543 (26%) were complete. Approximately 50% of the DataSchema variables can be generated across at least four cohort surveys while only 10% (n = 4) variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%.
Data harmonization can improve the comparability of variables both within and across surveys. For future cohort surveys, the authors advocate more consistency and standardization in survey questionnaires within and between surveys.
The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team-Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in-person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes.
Learning outcomes were assessed via a three-part timed series survey. A set of self-report assessment items measured skills implemented at baseline and post-training.
Learning domain scores increased over time from baseline to post-training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team.
The MOTIVATE program is an effective collaborative-based model for developing oral health competencies and promoting evidence-based oral health care in nursing homes.
This study evaluates the impact of introducing dental therapists (DTs) into Children's Dental Services (CDS), a large non-profit organization in Minnesota. The aim is to assess the effect of DTs in improving access and reducing dental care costs in Minnesota by analyzing the trends in dental care delivery and procedures performed by CDS dentists and therapists.
Using 2009 to 2021 data from CDS, the study compares trends in patient volume, types of procedures, salary data and payments by dentists, DTs, and registered dental hygienists (RDH). Return on investment (ROI) trends are calculated using salary and revenues for each provider type.
After introducing DTs at CDS and implementing mobile clinics, the number of patients served and volume increased steadily, demonstrating increased access. DTs provided an increasing proportion of fluorides, sealants, and extractions through 2020. Interestingly 2021, there was a decrease for DTs, possibly due to Covid related workforce shortages. ROI analysis showed that DTs' ROI dramatically rose, eventually surpassing dentists, while RDHs maintained a constant ROI. Dentists' ROI also initially increased after adopting DTs in the practice.
Integrating DTs at CDS improved access by expanding mobile clinics, increasing patient volume, and redistributing procedures, while demonstrating a positive return on investment. Results suggest that adopting the DT model may be a promising practice for other organizations seeking to improve access to dental care, increase operational efficiency, and boost the dental care team's ROI.
The aim of this study was to assess the knowledge of state dental directors regarding their state's professional practice act, specifically scope of practice laws regarding point-of-care chairside screening for diabetes.
A cross-sectional study design was used to examine the 50 state dental directors' knowledge of policy around point-of-care diabetes testing in their state. A five-item survey instrument was designed in a web-based platform and electronically distributed in 2022.
Thirty-seven states (74%) responded to the survey. Regarding whether it was within the scope of practice for dentists to provide chairside point-of-care HbA1c screening, 17 states (46.0%) responded “yes,” 5 states (13.5%) responded “no,” and 15 states (40.5%) responded “don't know.” Of the 17 states who provide diabetes testing, four states (23.5%) reported that dentists were reimbursed, nine states (53.0%) reported they were not reimbursed, and four states (23.5%) reported they did not know regarding reimbursement.
There is significant state heterogeneity with regard to laws, regulations, and reimbursement for chairside diabetes testing in the United States. This is accompanied by vagueness and lack of specificity in the state education laws. For more widespread promotion and adoption of this evidence-based screening, the entire dental community including clinicians, educators, policymakers, payers, and professional organizations at all levels are encouraged to work together to advocate for clarification and specificity in the language of state education laws as well as reimbursement for this vital service.
With the help of a national community-based survey, the analysis aimed to estimate the number of adults in Bangladesh who used dental services (DSU).
The 8185 participants (18–69 years old) in the Bangladesh cross-sectional STEPS survey in 2018 provided national data for analysis. Predisposing, enabling, and need factors for DSU were included in the interview data, physical examinations, and biochemical analyses. To estimate the DSU (last 12 months) predictors, Poisson regression was employed.
Seven out of 10 participants (71.0%) had never DSU, 13.2% within the past 12 months, and 15.9% more than 12 months ago. In terms of predisposing factors, the final model showed a negative relationship between past 12-month DSU and living in the northern region (adjusted prevalence ratio-APR: 0.75, 95% CI: 0.59, 0.96). The enabling factors of living in an urban area (APR: 1.19, 95% CI: 1.01, 1.41) and seeing a doctor or other healthcare provider within the previous year (APR: 1.37, 95% CI: 1.08, 1.74) were positively correlated with DSU. In terms of need factors, dental pain (APR: 15.37, 95% CI: 9.68, 24.40), multimorbidity (APR: 1.26, 95% CI: 1.02, 1.55), oral health impact (OHI) speech problem (APR: 1.35, 95% CI: 1.13, 1.63), and OHI felt tense (APR: 1.34, 95% CI: 1.10, 1.64) were positively associated with DSU.
A low proportion of participants had DSU in the past 12 months and several associated factors were identified.
This study examined patients' satisfaction with services provided by different oral health providers, their intent to return for additional care, and associations with patients' demographics and service characteristics.
Descriptive analyses and multivariable ordinal logistic regressions were conducted using survey data from 898 patients who received care at Apple Tree Dental (ATD) in Minnesota during 2021. The questionnaire included 12 statements on patient satisfaction with the clinician's ability to explain the dental diagnosis and treatment options, to be considerate of the patient's needs and dental anxiety, and to provide technically competent services.
In general, patients reported high satisfaction with dental care and a strong intent to return to ATD for future services. No significant differences in patient satisfaction were observed by provider type. Patients' intent to return was higher among non-White respondents (OR = 1.76; 95% CI = 1.06–2.92) and patients who were more satisfied with their providers' technical competence/treatment (OR = 1.47; 95% CI = 1.37–1.57). The association between intent to return and patient satisfaction with providers' information/communication was stronger for patients treated by dental hygienists. The association between intent to return and patient satisfaction with providers' technical competence/treatment was also stronger for patients who were more satisfied with providers' information/communication and understanding/acceptance, and for those treated by their desired or usual provider.
The study underscores the benefits of introducing dental therapists to the oral healthcare team, showing that this can be achieved without sacrificing either the quality of patient care or patient satisfaction.
Little is known about dental caries experience in adolescents with overweight and complex special health care needs (SHCNs).
Adolescent data (10–17 years) from the 2016–2020 National Survey of Children's Health (n = 91,196) was analyzed. The sample was grouped into the following: more complex SHCN and overweight, more complex SHCN without overweight, less complex SHCN and overweight, less complex SHCN without overweight, no SHCN but with overweight, and neither SHCN nor overweight. A multivariable-adjusted logistic regression model was conducted.
Adolescents with more complex SHCNs with (OR: 1.82, 95% CI: 1.44–2.30, p < 0.001) or without overweight (OR: 1.51, 95% CI: 1.30–1.76, p < 0.001) were at higher odds of experiencing dental caries compared to healthy adolescents. No significant associations were observed between adolescents with less complex or no SHCN regardless of the overweight status with healthy adolescents.
Adolescents with more complex SHCNs, irrespective of overweight status, experienced a higher caries severity than adolescents with no SHCNs or overweight.
This pilot study examined the association between food insecurity and edentulism among older adults in Washington State.
This study focused on adults aged 50 years and older, who were recruited through seven community-based organizations in Washington State. The exposure variable was food security level (high, marginal, and low/very low food security) assessed using the 10-item U.S. Adult Food Security Survey. The outcome was edentulism, defined as having zero natural teeth. Confounder-adjusted odds ratios (OR) and 95% confidence intervals (CIs) were generated using binary logistic regression models (α = 0.05).
Of the 216 participants, 28.7% (n = 62) had low/very low food security and 7.9% (n = 17) had zero teeth. Older adults with low or very low food security had greater odds of being edentulous compared to those with marginal or high food security, although the difference was not statistically significant (OR: 1.39; 95% CI: 0.46, 4.20; p = 0.56).
Future research should explore food insecurity-focused interventions aimed at preventing edentulism in older adults in a broader effort to address oral health inequities.
To evaluate parent knowledge and belief changes following the MySmileBuddy (MSB) early childhood caries (ECC) intervention.
Pre- and post-intervention surveys were completed by 669 parents of children with visually-evident ECC from among 977 participants in a 6–12-month pragmatic community-based caries management trial administered by community health workers (CHWs). Six domains of knowledge about caries and motivating and facilitating determinants were assessed via 26 survey items. Principal components analysis and reliability testing reduced dataset dimensionality. Parent and CHW characteristics were analyzed as potential moderators. Paired T-tests measured pre-to-post-intervention changes. Generalized estimating equations accounted for within-participant correlation with significance set at p < 0.05.
Twenty items consolidated into five factors (saliva, hygiene, diet, seriousness/susceptibility, and outcome expectations). Six additional items were evaluated individually. Positive post-intervention changes (p < 0.0001) were observed across all factors and all but one individual item (tooth decay is very common). Greatest knowledge increases related to caries as a bacterial disease in two measures, the saliva factor and a single caries belief item tooth decay is an infectious disease (0.59 unit increase, 95% CI [0.55, 0.64] and 0.46 unit increase, 95% CI [0.4, 0.51], respectively), and in the value of fluoridated water over bottled (0.46 unit increase, 95% CI [0.39–0.53]). Most parents improved knowledge of ECC salivary (72%) and dietary risks (57%), and preventative hygiene behaviors (59%).
MSB enhanced knowledge and beliefs about caries and confirmed hypothesized mediators of behavior change among parents of high-risk children. Engaging peer-like CHW interventionists may have moderated intervention effects, warranting further exploration.
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