Journal of public health dentistry最新文献

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.

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.