Journal of public health dentistry最新文献

Oral and mental health are integral to overall health and well-being. Primary dentition caries is associated with poorer oral and general health and faster aging by midlife, but it remains unclear whether these associations also hold for mental health.

Objectives

To investigate whether primary dentition caries, caries experienced in adolescence and adulthood, and caries trajectories across the life course are associated with mental disorders in the fifth decade of life in two New Zealand birth cohorts.

Methods

Data on childhood caries and adult mental disorders were obtained from the Dunedin Multidisciplinary Health and Development Study and the Christchurch Health and Development Study. Generalized Linear Models (GLMs) were used to estimate associations between caries at age 5 and mental disorders at age 45/40 for Dunedin and Christchurch studies, respectively. Additional analyses using Dunedin Study data investigated associations between permanent dentition caries trajectories from ages 9 to 45 and mental disorders at age 45. All analyses adjusted for sex, perinatal health, childhood SES, childhood IQ, and adult personality.

Results

Primary dentition caries experience was not associated with mental disorders in midlife in either cohort. Dunedin Study participants who were in a less favorable permanent dentition caries trajectory had higher rates of mental disorders at age 45 than those in the low-caries trajectory.

Conclusions

People who experience poor oral health across the life course are also those who suffer from poorer mental health in mid-adulthood. A lifelong trajectory of poorer dental health indicates poorer mental health and well-being in adult life.

Objectives

School-based dental sealant programs are important in expanding the reach of oral health care to underserved populations. However, data collection during these visits is also valuable for public health surveillance and program planning. This study aimed to utilize these data to identify groups disproportionately impacted by pandemic closures.

Methods

SEAL!ND is a program in North Dakota that serves schools, where 45% or more of students are enrolled in the free and reduced-fee school lunch program. SEAL!ND provides dental screening, application of fluoride varnish and dental sealants, and oral health surveillance. Data are collected for evaluation and to track pediatric oral health. In the spring of 2020, the COVID-19 pandemic and subsequent public health emergency stalled the program and left these children without access to preventive dental services. We examined previous dental visits, untreated decay, treated decay, and early and urgent care need during the 2019–2020, 2020–2021, and 2021–2022 school years. Binomial and multinomial logistic regressions were conducted to examine the odds ratios of the oral health outcomes by race.

Results

The proportion of poor outcomes had noticeably increased for American Indian students compared to White students. There was also increased odds of untreated decay, treated decay, and early and urgent care need for American Indian students compared to White students.

Conclusions

These findings aid in identifying groups of students whose oral health was disproportionately impacted by the disruption in community-based, preventive dental care services during the pandemic for the purpose of future intervention.

Objectives

This study investigated regional trends in delays between the histological diagnosis of oral and oropharyngeal cancer and initiation of treatment across Brazil's federal units from 2013 to 2019.

Methods

A retrospective, observational study was conducted using secondary data from the Brazilian Health System Database (DATASUS) for the years 2013–2019. Variables collected included the year of treatment, sex, age group, anatomical location, disease stage, treatment method, and federal unit of Brazil. Thematic maps were generated, and time series were analyzed using joint-point regression.

Results

A total of 72,062 cases were included in the study. Majority of cases were of men (79.32%) and individuals older than 45 years (91.15%). Treatment was initiated earlier in younger patients, in cases of lip cancer, and among those who had undergone surgery. In 11 states, a significant decrease was observed in initiating treatment for oral cancer 60 days from diagnosis, whereas a significant increase was observed in three states. For oropharyngeal cancer, a significant decrease was observed in initiating treatment at 60 days from diagnosis in three states, whereas a significant increase was observed in five states.

Conclusions

The findings revealed a high degree of heterogeneity in treatment delays for oral and oropharyngeal cancer across Brazil from 2013 to 2019. The northern states of Brazil exhibited a high percentage of treatment delays exceeding 60 days.

Objectives

The aim of this study was to assess the relative strength of association of four state-level factors—Medicaid reimbursement, Medicaid adult dental benefit (MADB) generosity, dentist Medicaid participation, and dentist supply—on individual-level dental care use among children and adolescents in Medicaid.

Methods

This national cross-sectional study used 2018–2019 National Survey of Children's Health data to estimate dental care utilization among children aged 1–17 enrolled in Medicaid. Subgroup analyses were conducted by child age group. A hierarchical regression approach was used; a series of logistic regression models assessed relative effect sizes among the four state-level variables.

Results

Among children aged 1–17, and the age 1–3 subgroup, dentist Medicaid participation was positively associated with dental care use. Among children aged 4–11, children in states with Emergency/No dental coverage for adults had greater odds of having a dental visit compared to children in states with Extensive dental coverage. Among adolescents aged 12–17, no state-level factors were associated with dental utilization.

Conclusions

There was considerable variation by age group in the associations of state-level factors on dental care use among children and adolescents in Medicaid. Dentist participation in Medicaid was associated with dental care use among very young children. State-level policy levers have the potential to improve access to dental care for children enrolled in Medicaid, and are critical to achieve improvement toward oral health equity for children.

Objective

This study aimed to investigate changes in oral health services from 2012 to 2021 and identify factors influencing the number of different types of services directly provided by all Federally Qualified Health Centers (FQHCs).

Methods

Data from the 2012–2021 Uniform Data System were analyzed using multilevel mixed-effect negative binomial regression models. These models explored associations between oral health staffing, federal grant revenue, and state Medicaid dental policies for adults, and the number of different types of oral health services provided at FQHCs. Regressions were adjusted for FQHC and state characteristics, and survey year.

Results

FQHC visits for any oral health service increased significantly with each additional full-time equivalent (FTE) in all types of oral health staffing, ranging between 0.8% and 13.7% (e.g., IRR = 1.137, 95% CI = 1.126–1.148 for preventive services by dental hygienists/therapists). Preventive dental visits increased significantly by 32% (IRR = 1.320, 95% CI = 1.028–1.694) for every 1% increase in the proportion of capital development grants to the total revenue. Although not statistically significant, FQHCs in states with extensive Medicaid dental coverage had a 2%–7% increase in all types of oral health services except emergency services compared to those in states with emergency-only coverage.

Conclusions

This study found that increasing dental staffing, particularly of dental hygienists/therapists, enhances FQHCs' ability to provide preventive services. Capital development grants also positively influence preventive dental care delivery. Expanding Medicaid dental coverage may also increase service utilization, particularly among underserved groups, reducing oral health disparities.

Objectives

Antibiotic prescription trends in dentistry in Japan remain underexplored. This study aimed to describe these trends and evaluate the impact of the national antimicrobial stewardship program launched in 2016.

Methods

Using Japan's national administrative claims database from fiscal year (FY) 2015 to FY 2020, this cross-sectional study comprehensively analyzed trends in antibiotic prescription by dentists. Prescription rates were computed per 1000 inhabitants yearly and standardized to the FY 2015 national population. Changes in prescription rates were evaluated using Poisson regression analysis.

Results

In FY 2020, the total number of antibiotic prescriptions was 134.4 per 1000 inhabitants per year, showing a 6% decline over the 6-year period (95% confidence interval, 6%–6%). Third-generation cephalosporins constituted 52.3% of dental antibiotic prescriptions in FY 2020, though the proportion had slightly decreased. In hospitals, prescriptions of third-generation cephalosporins decreased from 64.9% in 2015 to 20.3% in 2020, being replaced by penicillin (from 15.0% to 64.0%). However, in clinics, the magnitude of the change was small (third-generation cephalosporins, 60.5%–53.1%; penicillin, 10.2%–22.2%).

Conclusions

Third-generation cephalosporins continue to dominate dental antibiotic prescriptions. The increase in penicillin use was much more pronounced in hospitals than in clinics. Strengthening antimicrobial stewardship, particularly in clinics where the majority of dental care is provided, is crucial.

Objectives

The COVID-19 pandemic has fostered the use of teledentistry worldwide. However, teledentistry remains underutilized in Japan due to a lack of clarity regarding its target population. This study aimed to determine the current demands of patients of dental clinics in Saitama, Japan; enable dental care professionals to adopt teledentistry; and examine which patients could be targeted for teledentistry.

Methods

This cross-sectional study involved a survey of dental patients who visited one of 28 participating dental clinics in September 2020 in Saitama, Japan. The patients were asked about their demographic information, impact of the COVID-19 pandemic, and teledentistry—including future demands (whether they would like to receive teledentistry consultations). Data were analyzed using descriptive statistics and a multiple logistic regression model.

Results

Questionnaires were distributed to 1335 patients, 1312 of whom responded (response rate: 98.3%). The analysis included 835 of the 1227 valid responses to the question about the future demand for teledentistry (“demand” group: 299 patients; “unnecessary” group: 536 patients). The difference in the frequency of dental visits between the “demand” and “unnecessary” groups was significant (p = 0.04). The multiple logistic regression model identified “visited dentists only when necessary” as an independent contributor to the future demand for teledentistry (odds ratio = 1.60, 95% confidence interval = 1.00–2.57).

Conclusions

Teledentistry presents an opportunity for dental care for those who do not habitually visit the dental clinic. Further research should explore the type of dental consultation required by infrequent dental patients and how teledentistry can meet these needs.

Objective

To evaluate the effect of childhood dental attendance pattern on self-rated oral health in middle adulthood among the British population.

Methods

Data from the 1970 British Cohort Study involving participants born in England, Scotland, and Wales were used. Self-rated oral health was assessed at age 46. Childhood dental attendance patterns, derived from follow-up surveys at ages 5, 10, and 16, were classified as ‘always’, ‘sometimes’, or ‘never’ regular. Logistic regression was performed to estimate the effect of childhood dental attendance on adult oral health. Subgroup analyses by education level and oral hygiene practices examined potential variations across these factors.

Results

This study analyzed data from 4699 participants. An association was found between childhood dental attendance pattern and self-rated oral health in middle adulthood. The odds of reporting poor oral health were higher among those with ‘sometimes’ and ‘never’ regular dental attendance patterns than ‘always’ regular attenders. However, this association became insignificant after adjusting for covariates. Subgroup analyses revealed that ‘sometimes’ and ‘never’ regular attendance patterns were associated with higher odds of reporting poor oral health among participants who brushed less than twice daily and those with lower parental academic qualifications.

Conclusion

This study suggests that childhood dental attendance is associated with perceived adult oral health, though this relationship diminished after adjusting for covariates. However, the association persisted among those who brushed less than twice daily and had lower parental academic qualifications. It underscores the importance of both demographic factors and health-related behaviors in determining long-term oral health outcomes.

Objectives

Primary care lacks emphasis on oral health (OH) despite its major effects on one's overall health. This mixed-methods bibliometric study was conducted to assess the content of OH in primary care journals.

Methods

Sixty-seven of the most influential journals were identified from primary care specialties and disciplines using Scopus CiteScore metrics and expert opinion. For each specialty, one journal was chosen as the “core journal.” A search string was then developed to extract OH related articles found within a ten-year time frame (2012–2021) which were subsequently analyzed for OH content, trends, and article type.

Results

Of the 1784 articles extracted, 1068 met inclusion criteria. When compared with the total number of articles published by journals in any category, OH articles comprised less than 1% of total articles published between 2012 and 2021. Family medicine showed a borderline significant increase in OH articles over this time period while pediatrics showed a significant decline. Among the core journals, there was a statistically significant decline in OH articles published in geriatrics and pediatrics. Case reports and review articles were the most common type of OH article published. General oral lesions and population-specific OH delivery were the most common topics published.

Conclusion

This review highlights the relatively low prevalence of OH articles in primary care journals and defines the most prevalent types of OH articles. Further studies are needed to understand the reasons for the lack of OH articles in primary care journals and the implications for primary care providers and learners.

Objectives

There has been an increasing interest in addressing the equity issue of accessing dental care for low-income elderly. This study aimed to estimate the marginal effects (ME) of dental insurance coverage for seniors on dental care utilization and oral health status outcomes. We also estimated the ME of dental insurance across income subgroups.

Methods

Data was sourced from the 2017/18 Canadian Community Health Survey (CCHS)-Annual component. The ME analysis included individuals aged ≥65 years residing in Ontario (n = 10,030). ME were derived from multivariate probit regression models for dental care utilization and oral health status outcomes.

Results

Dental insurance increased the likelihood of reporting excellent/very good oral health and never avoiding foods due to oral problems by 6.9% (ME:6.9, 95% CI: 5.4–8.3) and 3.5% (ME: 3.5, 95% CI: 1.9–5.1), respectively. Dental insurance increased the likelihood of dental visits within the past year by 11.3% (ME: 11.3, 95% CI: 9.8–12.8) and decreased the likelihood of dental visits only for emergencies by 11.2% (ME: −11.2, 95% CI: −12.5 to −9.9). Compared to low- and high-income groups, dental insurance had the highest ME for the middle-income groups for dental visits within the past year (ME middle: 13.1, 95% CI: 10.5–15.7) and dental visits only for emergencies (ME middle: −14.4, 95% CI: −16.0 to −12.8).

Conclusion

Dental insurance can improve the utilization of dental care and can help mitigate the negative effects of poor oral health in elderly populations.