Journal of public health dentistry最新文献

Objective: To assess the relationship between socioeconomic factors and the provision of oral health services in Primary Healthcare with mortality due to oral cancer in Brazil.

Methods: This ecological study was conducted across 1105 Brazilian municipalities, encompassing 11,412 oral health teams (OHTs). The outcome variable was the oral cancer mortality rate, standardized by age and sex. Socioeconomic factors and variables related to the oral health services provided by municipal OHTs were considered explanatory variables. We employed multilevel Poisson regression models with random effects at the municipal level to assess the association between oral cancer mortality rates and explanatory variables.

Results: At the municipal level, oral cancer mortality was negatively associated with higher human and social development and greater income inequality but positively linked to higher rates of population aging and greater coverage of primary and oral healthcare services. At the OHT level, mortality reduction was observed among those who received specialized support and had greater availability of consultations. Active case-finding for cancerous lesions and care monitoring were also linked to lower mortality. Conversely, the identification of high-risk vulnerable patients by these teams was associated with higher mortality.

Conclusion: This study suggests that oral cancer mortality in Brazilian municipalities is influenced by socioeconomic factors and the availability of oral health services.

Introduction: Individuals with intellectual or developmental disabilities (IDD) often experience more negative oral health outcomes.

Methods: We implemented and tested a comprehensive strategy in 39 IDD group homes to examine whether skills-based training for direct support professionals (DSP) and individualized oral health planning for residents could improve DSP assistance and provision of oral health care for residents and oral health status. Our sample comprised 19 intervention homes and 20 control group homes, with 61 residents with IDD and 77 DSP. The strategy involved providing didactic and experiential skills-based training, combined with in-home coaching to DSP with resident participation over the course of 16 weeks. DSP in control homes received educational brochures. DSP attitudes, skills, and behaviors; and resident oral health outcomes were measured at baseline, 4 months later (post-intervention), and 12 months after baseline. Analyses compared the intervention and control conditions at 4-months and 12-months.

Results: Results suggest that the intervention influenced DSP skills and behaviors. Among residents, results showed improved outcomes for teeth in the lower anterior sextant only; intervention effects largely abated by 12-month follow-up.

Discussion: Findings demonstrate that skills-based, experiential training with coaching can be effective in enhancing skill sets and increasing behaviors about oral health among DSP. In addition, results showed that the strategy used can improve oral health outcomes for residents. However, given that there were only improved outcomes in residents' lower anterior sextant, more research is needed to determine how to adequately assess and improve resident outcomes.

Objectives: Social determinants of health (SDOH) include healthcare access, neighborhood/built environment, social context, economic stability, and education (including literacy and numeracy). These are known factors for health outcomes. The purpose of this research is to consider one SDOH category: general literacy/numeracy levels, with poor oral health indicators in a comparison of U.S. national and Appalachia data, a region with many poor healthcare indicators.

Methods: For this ecological study, literacy/numeracy data were from the Programme for the International Assessment of Adult Competencies (PIAAC) Survey of Adult Skills, 2012-2017. Oral health indicators were from the Behavioral Risk Factor Surveillance System, 2012-2016.

Results: Of a possible score of 500 for literacy/numeracy, the mean national scores were 263.5(95% CI: 262.0, 265.1) and 249.1 (95% CI: 247.5, 250.6), respectively. The mean scores for all Appalachian counties were similar (262.2; 95% CI: 261.3, 263.1; p = 0.7258) and (247.6; 95% CI: 246.6, 248.6; p = 0.6872), respectively. However, within state comparisons had several non-Appalachian counties with higher literacy/numeracy scores than their Appalachian counties (Kentucky, Ohio, and Virginia) while in Alabama, the reverse occurred. Overall, state-wide, dental visits were not significantly different from national levels in crude percentages; however, missing any permanent teeth and edentulism were higher than the nation.

Conclusion: Health concerns, and oral health concerns in particular, are significant for the Appalachian region. However, dental visits and the mean overall general literacy/numeracy skills were not significantly different from the nation's, indicating that other factors are driving poor health outcomes within Appalachia from an ecological perspective.

Background: Oral Healthcare workers, including dental students, face a great risk of COVID-19 infection. High COVID-19 vaccination coverage is essential for a protected workforce. This study, which aims to document the COVID-19 vaccination experience among dental students and employees from Canadian dental schools during the COVID-19 pandemic, provides crucial insights that can significantly impact future vaccination strategies.

Methods: This study used data from a prospective cohort conducted between April 2021 and May 2022. We recruited 600 participants, including dental students, faculty, and support staff from 10 Canadian dental schools. Data were collected monthly from all subjects. Vaccination acceptance and vaccination time were assessed. Logistic regression models were performed to identify predictors of COVID-19 vaccine acceptance and late vaccination. In order to detect hesitation tendencies, descriptive statistics were used to observe the distribution of time to vaccination between age groups of employees and students.

Results: Out of 600 participants at baseline (70% female; average age 36 years old), 91% received at least one dose of the COVID-19 vaccine. No associations were found between sociodemographic factors and COVID-19 vaccine acceptance. Individuals aged 50-59 were less likely to delay the vaccination than most of our sample. Students presented more outliers for later vaccination times, particularly in younger age groups.

Conclusion: High vaccination acceptance among dental students is crucial for promoting professionalism and influencing patients. Integrating vaccine advocacy into their education might enhance vaccination uptake in the general population.

Objectives: To investigate the relationship between oral microbial diversity and depression symptoms in the U.S.

Population:

Methods: We utilized the US National Health and Nutrition Examination Survey (NHANES; 2009-2012) to assess the association between oral microbial diversity and depression symptoms. A cut-off PHQ-9 score of 15 was used to define severe depression symptoms. We conducted the multivariate linear regression to explore the association of the amplicon sequence variants (ASVs) with PHQ-9 scores. A restricted cubic spline (RCS) model was introduced to curve the dose-response relationship. A logistic regression model was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of the association between ASVs and the risk of severe depression symptoms. Based on Bray-Curtis dissimilarity of beta diversity, analysis of similarity (ANOSIM) is used to assess the dissimilarity between different depression groups.

Results: A total of 1497 participants were included, with 111 (7.41%) meeting the criteria for severe depression. After adjusting for confounders, we found that ASVs were negatively correlated with PHQ-9 scores (β = -0.008, p = 0.014). The RCS plot showed a linear relationship (p_non-linear = 0.232). Logistic regression showed that ASVs were associated with a decreased risk of severe depression symptoms (OR = 0.992, p = 0.003). Analysis of β diversity identified a statistically significant difference (R = 0.087, p = 0.003). Additionally, we developed a nomogram to estimate an individual's risk of severe depression symptoms.

Conclusions: Alpha diversity of the oral microbiota was associated with a reduced risk of severe depression symptoms, which could contribute to the early identification and intervention of severe depression.

Objectives: Dental decay is endemic in the United States, underscoring the need to measure the utilization of caries risk management tools to elucidate the effect of prevention interventions in reducing the dental decay rates of individuals. An academic institution partnered with a third-party institute to call attention to the utilization and prevention measures associated with caries risk assessment (CRA) used with children 0-18 years. This environmental scan examined claims across the United States to evaluate the proportion of dental examinations, CRAs, and caries prevention procedures within a calendar year.

Methods: A 12-month deidentified participant list categorized by age, race, sex, state of residence, and treatment dates was provided from the third-party database containing 14,625,751 Medicaid and commercial claims for dental examinations, CRAs, and caries prevention procedures performed in the calendar year 2022.

Results: The final data set (N = 9,351,848 patient examinations), 86.8% had a caries prevention procedure completed at the examination visit. Still, only 29.4% had a CRA Current Dental Terminology (CDT) coded on the same day of the dental examination. There were higher numbers of CRAs in the Medicaid payor group in states that require CRAs in conjunction with a dental examination.

Conclusions: The utilization of the ADA CRA CDT codes, designed to stratify patients into caries risk categories of low, moderate, or high, was relatively low compared to the examination and prevention procedure claims. Consistent utilization of these codes would allow for more effective monitoring of patient outcomes, supporting a data-driven approach to assessing oral health over time.

Objectives: This cross-sectional secondary analytical study estimated dentist visits among foreign-born Middle Eastern and North African (MENA) children compared to US-born White and foreign-born White, Black, Hispanic, and Asian children. This is the first known study to provide national estimates for dental visits among MENA children who have historically been aggregated with the White population.

Methods: We used 2000-2018 National Health Interview Survey data (N = 358,686 children). We calculated age- and sex-adjusted prevalence estimates and performed multivariable logistic regression to test the odds of dentist visit utilization by race, ethnicity, and nativity. Covariates included age, family poverty level, health insurance coverage, and special health care needs.

Results: Dental visits at 6 months were approximately 64% for US-born White and foreign-born MENA children. Most (77.4%) foreign-born MENA children had a dentist visit in the past 12 months. Results were similar for US- and foreign-born White (80.8% and 79.9%, respectively) children. Fewer foreign-born Black (49.5%), Hispanic (47.7%), and Asian (54.6%) children had a dentist visit in the past 12 months. Results from logistic regression modeling showed that foreign-born MENA children's receipt of dental visits at 12 months was similar to US-born White children after adjustment (OR = 0.98; 95% CI = 0.76-1.27). Findings were similar for foreign-born White children. Foreign-born Black, Hispanic, and Asian children had lower odds of receiving dental visits at 12 months compared to US-born White children.

Conclusions: Findings suggest high dental care utilization among foreign-born MENA children. Additionally, dental care utilization for foreign-born MENA children was similar to their US- and foreign-born White peers. This study has implications for national health policy and policy reform for federal reporting standards for MENA populations.

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: 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.