Journal of public health dentistry最新文献

Background

While recent US policies restrict access to healthcare and resulting health disparities among the transgender community, little is known about oral health access and utilization among this population. This study assessed self-reported access to dental care among transgender adults living in the United States.

Method

The study sample included 1,284,526 observations representing a weighted population of 290,000,163 from Behavioral Risk Factor and Surveillance Survey (BRFSS) datasets. Transgender identity was dichotomized and tested for association with having a dental visit in the past year. Pearson chi-square statistics were computed for associations and multivariate logistic regression assessed the odds of seeing a dentist in the last year.

Results

Nearly all socioeconomic and healthcare access covariates were associated with transgender identity. A significantly smaller proportion of transgender respondents reported established employment graduating high school, income over $50,000, non-Hispanic White racial and ethnic identities, and a past-year medical checkup (all p < 0.01). In all three models and across all analyses, transgender respondents had significantly lower odds of having seen a dentist in the past year, compared to cisgender people.

Conclusions

To date, no research, aside from the present study, has assessed connections between transgender identity and oral healthcare access. The results of this analysis are consistent with other healthcare disparities that transgender people experience in that a smaller proportion of transgender respondents saw a dentist in the last year compared to cisgender respondents. Implications for establishing a foundation in future research to explore oral health access, utilization, and policy recommendations are discussed.

Objectives

This study examined the association of social determinants of health (SDOH) domains on oral health status.

Methods

We used the nationally representative 2022 Health Center Patient Survey and the 2021–2022 Area Health Resource File. We constructed seven domains on burden of SDOH disadvantage: (1) oral health behavior, (2) dental service use and access, (3) general health service use and access, (4) social, (5) economic, (6) contextual or physical environment, and (7) health condition indicators, and calculated a score per domain. We assessed the association between SDOH domains and four oral health measures: (1) poor self-assessed oral health, (2) low functional dentition, (3) acute dental need, and (4) chronic symptoms in logistic regressions.

Results

SDOH domains had different degrees of association with outcomes. Oral health behavior, health condition, and economic indicators were positively associated with all outcomes. General health service use and access, and contextual or physical environment were positively associated with all outcomes except for low functional dentition. Dental service use and access indicators were associated with higher likelihood of poor oral health (7.3%) and low functional dentition (2.5%). Social indicators were associated with higher likelihood of poor oral health (3.1%).

Conclusions

Findings highlight the importance of measuring the burden of SDOH disadvantage and including it in care provision. Findings indicate the need for more access through better integration of oral health within primary care, provision of nonclinical services to link patients with social services to promote oral health, and further support of these approaches by payer.

Objectives

This paper demonstrates International Caries Detection and Assessment System (ICDAS) training procedures and inter/intra-examiner reliability for lesion severity, activity, and filling criteria in an elementary school setting.

Methods

ICDAS training was conducted in December 2021 prior to a school-based cluster-randomized controlled trial. A total of 59 children (6–8 years old) in grades 1–2 from one school in Houston, Texas were recruited. Two licensed dentists received a 5-day training from an ICDAS trainer at the participating school. Thirty-eight children were evaluated at least once by each dental trainee, and 18 had repeat examinations. The ICDAS criteria were used to classify dental caries lesion severity (0–6), lesion activity (active/inactive), and filling material (0–9) of all visually available primary and permanent tooth surfaces. Inter and intra-examiner reliability between each dental trainee and the “gold standard” trainer was evaluated using Kappa statistics.

Results

For lesion severity, the examination indicated an inter-rater weighted Kappa of 0.77 (95% CI 0.71–0.82) and 0.82 (95% CI 0.77–0.87) for each trainee examiner compared to the gold standard examiner. The Kappas increased slightly from the first to second examinations (lesion-weighted Kappa: 0.76 to 0.84 and 0.82 to 0.84). The intra-rater reliability indicated excellent reliability for lesion and filling (0.83 to 0.94) and moderate for activity (0.58).

Conclusions

ICDAS training/calibration were essential to ensure accuracy and reliability of dental caries measurements. The study demonstrated that ICDAS training of dentists with no prior criteria experience is feasible in a community setting and can lead to high reliability and repeatability.

Objectives

There is growing momentum to introduce value-based payment (VBP) approaches into dentistry to help improve population oral health status. However, there are very few VBP models available for dentistry. This study designs and analyzes the feasibility of introducing oral health episode of care (EOC) bundles for use by policy makers, payers, and dental providers.

Methods

An oral health EOC bundle is a standardized care process based on a set of best practices that has the potential to improve patient care quality when all bundle items are provided. We used a panel of dental experts to guide the design of two preventive EOC bundles for children, a comprehensive examination bundle and a periodic examination bundle. We then conducted a 12-year retrospective longitudinal analysis to simulate the completion rate of the EOC bundles for children receiving Medicaid benefits in Arizona from 2008 to 2019.

Results

An average of 805,229 children were enrolled annually in the Arizona Medicaid program across the 12-year period. Approximately 31% of the Medicaid enrolled children had a preventive dental visit twice a year, and 23% completed two preventive EOC bundles. On average, 126,602 (16%) of patients started the comprehensive examination bundle and 279,194 (35%) of patients started the periodic examination bundle. Overall completion rates for the Comprehensive Examination and Periodic Examination Bundles were 73% and 79% respectively.

Conclusions

It is feasible to design a preventive oral health EOC bundle for children. The findings have implications for developing VBP approaches for oral health care.

Objective

To assess the performance of atraumatic restorative treatment (ART) in primary care among an elderly population in need of home-based dental care.

Methodology

It is an observational clinical study, more specifically a descriptive cohort study. The status of these restorations was evaluated1 year after placement. The analysis of ART's clinical performance was conducted through the direct clinical evaluation method, following criteria previously defined in earlier studies. Data were tabulated into sets of descriptive categories, allowing classification into a frequency distribution according to the evaluation score. Success and failure results underwent statistical evaluation using the chi-square test, with a significance level set at 5%.

Results

Elderly individuals (n = 35) participated in the study, where 103 restorations were performed in the home environment. The majority of participants were women (68.6%) with an average age of 72.3 years, and 54.3% faced difficulties in motor mobility. All received dental care exclusively at home, and 45.7% used dentures. There was a statistically significant difference (p = 0.0156) between the percentage of failures and successful cases (73.8%) without the need for ART replacement. The majority of ART interventions were on occlusal surfaces (44.9%), showing the highest percentage of restorations in good condition (84.8%), followed by mesio-occlusal (81.3%), while disto-occlusal cavities exhibited the highest failure rate (38.4%).

Conclusion

The ART demonstrates satisfactory survival rates in elderly patients after 1 year. This restoration can be a viable alternative for the treatment of older adults, especially in situations that require domiciliary dental care.

Objective

To explore the synergy between population health and public health by initiating a discourse about their interconnected roles, responsibilities, and approaches in achieving optimal health outcomes.

Overview

Population health and public health, although distinct, are interconnected disciplines critical for enhancing health outcomes. Population health focuses on analyzing health determinants and outcomes within specific groups, employing data to guide targeted interventions and policies. Public health, on the other hand, prioritizes broader preventive measures and community-wide interventions to safeguard health. Both fields benefit from a transdisciplinary approach that integrates strategies to address and improve health.

Such integration is essential for addressing health disparities and improving the efficiency of health systems. By combining the analytical strengths of population health with the implementation capabilities of public health, a more comprehensive framework can be developed. These collaborations will not only enhance the effectiveness of health programs but also promote health equity by leveraging collective expertise and resources. They will facilitate the development of interventions that are both preventive and responsive, capable of addressing the upstream determinants of health and the immediate needs of communities. Such transdisciplinary efforts were demonstrated within the oral health field during the COVID-19 pandemic.

Conclusions

The synergy between population and public health can lead to robust health outcomes, fostering comprehensive health promotion and disease prevention strategies. By aligning research, practices, and policies, these integrated approaches will transcend traditional boundaries within the healthcare sector to build efficient health systems.

Objective

To evaluate the association between starch intake (amount and type) and changes in dental caries among adults over 11 years.

Methods

Data from 1679 adults, aged 30 years and over, who participated in three consecutive surveys in Finland were pooled for analysis. Participants completed a validated semi-structured 128-item food frequency questionnaire at baseline, from which total starch intake (g/day and % energy intake) and the intake (g/day) of seven food groups high in starch (potatoes, potato products, roots and tubers, refined grains, pasta, wholegrains, and legumes) were estimated. Dental caries was determined during clinical examinations and summarized using the DMFT score, which was treated as a repeated outcome. The association between baseline starch intake and 11-year-change in DMFT score was tested in linear mixed-effects models adjusted for sociodemographic factors, behaviors, sugar intake, and health status.

Results

The mean DMFT score was 21.9 (95%CI: 21.6, 22.2) in 2000 (baseline), increasing by 0.47 (95% CI: 0.38, 0.56) in 2004/05, and additionally by 0.33 (95%CI: 0.20, 0.45) in 2011. Total starch intake was not associated with change in DMFT. This finding was similar irrespective of how starch intake was expressed (g/day or %EI). Of the seven food groups evaluated, only the intake of pasta was inversely associated with the DMFT score at baseline, but not with the change in DMFT over time.

Conclusion

Neither the amount nor the type of starch intake was associated with changes in dental caries over 11 years among Finnish adults.

Objectives

To investigate the effect of water filter pitchers on the concentration of different minerals in tap water.

Methods

Nine water filter pitchers (A–I) were chosen based on consumer preferences and Amazon reviews. Each filter was tested for its ability to modify the concentrations of fluoride, calcium, magnesium, potassium, and sodium in tap water. Tap water samples were collected before and after filtration, at various intervals (1, 5, 10, 30, 50, 75, and 100 L) during filtration, and analyzed using an ion-specific electrode (fluoride) and atomic absorption spectrometry (other minerals). Statistical analyses were conducted to compare filtered and unfiltered water mineral concentrations.

Results

Water filter pitcher effect: Filters F (p < 0.001) and G (p = 0.030) decreased fluoride concentrations. All filters except I (p = 0.235) and H (p = 0.717) decreased calcium concentrations (p < 0.01). Filters E (p = 0.018), D (p = 0.014), and G (p = 0.010) decreased magnesium concentrations. Filters I (p = 0.028) and D (p = 0.009) increased potassium concentrations. Filter A (p = 0.002) increased sodium concentrations, while C (p = 0.034) decreased sodium concentrations. Effect of filter aging: All filters affected mineral concentrations over time but to varying extents. Filter G had the most pronounced effect on reducing mineral concentrations compared to all others. No filter was able to completely remove fluoride from tap water, contrary to the claims made by three manufacturers.

Conclusions

The present study highlighted that water filter pitchers vary greatly in their ability to affect mineral concentrations in tap water during their use. Further research is needed to develop more effective water treatment solutions.

Objective

This retrospective chart review evaluated the relationship between specific dietary questions used in caries risk assessment and planned restorative treatment among patients attending a dental school's clinic.

Methods

Records for 6,218 adult patients attending the University of Iowa College of Dentistry who completed caries risk assessments and comprehensive oral examinations during 2018–2019 were included. The number of planned caries restorative treatments were compared between groups based on responses to specific dietary questions on the caries risk assessment. Analyses included chi-square and Wilcoxon rank-sum tests and logistic regression for factors associated with caries treatments.

Results

About 20% of subjects needed caries treatment, and regression analyses found that younger age, having unstructured meals, drinking sugared beverages daily, and drinking them for more than 30 min were significantly (p < 0.01) associated with having caries.

Conclusions

Specific and focused questions on dietary practices are strongly associated with caries, and may be useful in improving caries risk assessments.

Objectives

Social Determinants of Health (SDoH) have been linked to health, including oral health and oral health behaviors. Objectives of this retrospective records review were to evaluate the relationships between self-reported unmet social needs and (1) oral health measures and (2) dental service utilization in a pediatric population at a hospital-based dental clinic.

Methods

Children 2–5 years of age whose families had completed a SDoH survey and who had an encounter with one United States (U.S.) urban children's hospital dental clinic within 6 months (± 3 months) of the survey date were included. A chart review was performed, and information was collected about the child's (1) oral health (e.g., plaque level, presence of caries) and (2) dental service utilization (e.g., no-show rates, number of dental surgeries). The data of patients with one or more parental/caretaker-reported unmet social needs were compared with that of patients with no unmet social needs.

Results

Inclusion criteria were met by 2646 children. Those with unmet social needs had significantly higher no-show rates at scheduled appointments than those without unmet social needs (p-value <0.001). Patients who identified as African/Black were more likely to report unmet social needs. There was no statistically significant difference in oral health measures of patients with or without unmet social needs.

Conclusions

Children in this population demonstrated varying associations between unmet social needs, health measures, and health behaviors, suggesting a likely complicated association between unmet social needs and health.