Journal of public health dentistry最新文献

Objective: Given the significant opioid epidemic in the United States, we investigated opioid-analgesic prescription trends and high-risk prescriptions in Illinois between 2015-2022.

Methods: Data from the Illinois Prescription Monitoring Program were analyzed for opioid prescription rates and high-risk prescriptions (i.e., multiple-prescribing providers, concurrent benzodiazepine, ≥ 90MME dose). Demographics (sex, age, and rural/urban classification using the Illinois Primary Health Care Association-2020) of high-risk prescriptions between 2018-2020 were analyzed using chi-square tests.

Results: N = 45,522,885 opioid prescriptions were dispensed in Illinois between 2015-2022, declining by 47.1% (from 140.5 rate in 2015 to 74.4 in 2022). High-risk prescriptions comprise 12.6% of all prescriptions and decreased by 16.6% (from 16.9% in 2015 to 14.1% in 2022). Between 2018-2020, males received more high-risk prescriptions than females, although both males and females showed a reduction in ≥ 90MME prescriptions (19.5% vs. 15.9%, p < 0.0001) and multiple-provider prescriptions (36.1% vs. 27.3%, p < 0.0001). Individuals aged 56-70 received the highest high-risk prescriptions, while reductions in ≥ 90MME prescriptions occurred across all age groups. High-risk prescriptions were disproportionally dispensed in rural areas (67.8%), where reductions were greater in ≥ 90MME prescriptions (16.7% rural vs. 6.4% urban) and multiple-provider prescriptions (9.0% rural vs. 7.9% urban).

Conclusions: Despite declines in opioid-analgesic prescriptions in Illinois from 2015 to 2022, high-risk prescribing persists, particularly in rural areas and among specific demographic groups. Targeted, region-specific interventions and continued regulatory oversights are necessary to address geographic and population-level disparities in high-risk opioid prescribing.

Objectives: This study presents a trend analysis of Medication-Related Osteonecrosis of the Jaw (MRONJ) using US National Inpatient Sample (NIS) data from 2016 to 2022, providing insights into its epidemiology, comorbidities, and economics.

Methods: A retrospective cross-sectional analysis was performed using US MRONJ hospital admissions. Prevalence rates were calculated relative to Bisphosphonate patient numbers in the United States and hospital-based denominators. Statistical analyses included two-sample proportion (Z) tests, Cochran-Armitage trend tests, Welch t-tests, and multivariable linear and ANOVA models with false discovery rate (FDR) correction for multiple comparisons, effect sizes, market basket analysis.

Results: Cochran-Armitage trend tests revealed significant increasing trends in MRONJ prevalence across all denominators: total NIS hospitalizations (p = 0.037), dental-related hospitalizations (p = 0.012), and bisphosphonate-exposed patients (p < 0.001). Females were more affected with MRONJ than males consistently across all years (p = 0.188). Whites had the highest number of cases across all years (p = 0.774). No region or income bracket stood out as highest or lowest. Medicare is the primary payer with 61%-80% of patients covered (p = 0.497). The average age of patients is around 70 years across all years. The average length of stay in the hospital ranged from 4 to 8 days and the average daily charges ranged from $15,000 to $20,000. Hypertension is the most common co-morbidity (except 2018).

Conclusion: The study highlights the incidence of MRONJ, its demographic disparities, economics, and the need for enhanced prevention and cost-effective management strategies.

Objectives: Despite decades of national and global strategies, persistent inequities in oral health outcomes, access, and service provision remain. Existing frameworks often fail to integrate clinical and behavioral factors with social, cultural, and political determinants. This study aimed to map and evaluate oral health frameworks using Hodges' Health Career-Care Domains-Model (HCM), a meta-framework that spans clinical, behavioral, sociological, and political domains. The goal was to identify conceptual gaps and opportunities for greater integration.

Methods: A structured scoping review was conducted using MEDLINE, CINAHL, EBSCO, and search engine Google Scholar (1995-2025) to identify oral health-related conceptual frameworks. Frameworks were eligible if they addressed oral health determinants, behaviors, policies, or interventions. Two reviewers independently screened records and analyzed full-text articles. Frameworks were categorized by theoretical orientation and mapped against the four HCM domains to identify patterns of emphasis or omission.

Results: Of 226 identified records, 21 frameworks met inclusion criteria. These were classified into three thematic groups: balanced (addressing all domains), clinically led (focused on clinical/behavioral aspects), and policy/public health-focused (emphasizing sociological/political factors). Seven cross cutting themes emerged, including health promotion, systems integration, social justice, and cultural safety. While many frameworks promoted equity and policy reform, few offered implementation guidance or had been empirically validated.

Conclusions: HCM proved useful for systematically comparing frameworks and revealed consistent underrepresentation of political and structural domains. It offers a practical tool for oral health professionals, educators, and policymakers developing integrated oral health models that align with equity, sustainability, and universal health coverage goals.

Objective: This study aims to evaluate the effectiveness of specialized oral nursing clinics for residents of Hong Kong and Macau. By optimizing the outpatient process to enhance treatment efficiency and improve the healthcare experience of Hong Kong and Macau patients in mainland China, this research provides evidence-based insights to address the challenges of low cross-regional treatment efficiency and complex procedures.

Methods: A specialized oral nursing clinic was established by a hospital group, implementing an innovative "one center, multiple branches" referral model. This model integrates the Oral Medicine Center with community health clinics to optimize the allocation of healthcare resources. The outpatient nurses are all specialized oral nurses with prescriptive authority. A cluster sampling method was used to compare data from January to March 2023 (before implementation) and January to March 2024 (after implementation). The evaluation indicators included patient volume, waiting time for consultations, expected treatment completion rate, and patient satisfaction.

Results: After implementation, the proportion of patients from Hong Kong and Macau increased from 2.0% to 6.8% (p < 0.01). The average waiting time for consultations decreased from 40.16 ± 17.39 min to 33.19 ± 15.61 min (p < 0.01). The expected treatment completion rate increased from 83.6% to 90.1% (p < 0.01), and patient satisfaction improved from 90.9% to 96.9% (p < 0.01).

Conclusion: The specialized oral nursing clinic, combined with the "one center, multiple branches" referral model, effectively simplifies the consultation process, improves service efficiency, and enhances patient satisfaction. This approach is innovative, scientifically sound, and replicable, providing practical evidence for the joint development and sharing of medical resources in the Greater Bay Area.

Trial registration: Not applicable.

Background: There is limited information about oral health awareness among Arab immigrants and refugees (AIR) in the United States, though research conducted on this demographic globally has shown a major correlation between poor oral health outcomes and sociodemographic factors. This study examined oral health practices and awareness of the increased gingivitis risk during pregnancy among AIR in Southern California.

Methods: This was a cross-sectional survey on oral health knowledge and access barriers among male and female AIR participants recruited via community organizations and dental clinics. Bivariate and multivariate analyses evaluated the association between oral health awareness and demographics, oral health literacy, general health knowledge, and knowledge of pregnancy-related gingivitis risk.

Results: The sample included 73 participants (31 males, 42 females), mostly aged 18-30; 67% held bachelor's degrees or higher, and 41% had immigrated due to war or violence. Females showed higher Oral Health Risk Awareness Scores than males (0.75 vs. 0.61, p < 0.006), with no significant differences by age or ethnicity. Most respondents reported financial and language barriers to dental care. Although over 75% recognized a link between oral and general health, only 38% knew of the increased periodontal risk during pregnancy.

Conclusion: The financial, linguistic, and educational obstacles that AIR populations must overcome to obtain dental care pose challenges and have an impact on their awareness of the risks to their oral health. These findings highlight the importance of culturally sensitive health education and outreach efforts.

Practical implications: Culturally appropriate programs and multilingual materials are necessary to improve care by addressing AIR's knowledge of gingivitis risks and promoting preventative dental care.

Purpose: Few studies have explored dental hygienists' views on health behaviors like food insecurity or recommending preventive care such as the HPV vaccine. This study examined current practices, barriers, and readiness to implement screenings for food insecurity (FI), HPV risk, and vaccine recommendation.

Methods: A cross-sectional survey was conducted (August 2024) among Oklahoma dental hygienists. Using concepts from the Transtheoretical Model and the Theory of Planned Behavior (TPB), an embedded mixed-methods survey evaluated respondent readiness to conduct FI screenings and HPV risk assessment/vaccine recommendation. Analyses included descriptive statistics and χ² tests to determine associations between intent and constructs of TPB. Additionally, content analysis of open-ended questions identified barriers and facilitators to adopting these practices.

Results: Among respondents (n = 92), the majority were not yet considering (precontemplation) screening for FI (67%), risk assessment for HPV (58%), or providing the HPV vaccine recommendation (78%). Most hygienists displayed a positive attitude toward these practices, yet lacked intent due to low perceived behavioral control and subjective norms (p < 0.001). Qualitative content analysis revealed barriers, including a lack of knowledge (41%) and awareness (18%), low confidence (10%), and considering such practices outside the scope of dental care (15%). Despite this, hygienists reported education (13%) and access to resources (10%) as facilitators in initiating HPV and FI related conversations.

Implications: Despite the low readiness, hygienists reported a willingness to engage in these critical public health issues with appropriate training and support. A stage-based training program in Oklahoma may enhance dental hygienists' knowledge and confidence, thereby improving preventive care and health outcomes.

Objectives: This investigation explores how gender, career stage, and rurality of graduates' hometowns relate to dental practice location, specifically within Alabama's rural communities.

Methods: This cross-sectional study explored demographics and practice locations for 2000-2020 graduates (N = 1233) from the state's dental school. This investigation compared findings across multiple definitions of rural status.

Results: Gender emerged as a significant predictor of rural practice for only one of the rural definitions. Females were less likely than males (6% vs. 12%) to practice in a low-population county (< 50,000), χ² = 11.03, p < 0.001. When controlling for both career stage and rurality of hometown, males are 2.04 times more likely (95% CI [1.29, 3.21]) to practice in a low-population county as compared to females, p = 0.002. Among graduates from rural or workforce shortage areas, no differences emerged in practice location based on either gender or career stage. Graduates from a rural county are significantly more likely than their non-rural peers to practice rural. Early-career dentists are not working in rural locations at significantly different rates from their mid-career peers.

Conclusions: More providers are needed to serve rural residents and graduates with rural upbringing are the most likely to fulfill this need. Rural practice appears to attract males and females in similar proportions, but more males than females gravitate towards low-population counties. Given populations and workforce trends, dental educators, policy makers, organized dentistry, and rural communities must all implement initiatives incentivizing dental practice in Alabama generally and her rural communities specifically.

Objective: To establish expert consensus on the critical factors shaping implementation of oral health assessment in Australian residential aged care (RAC) using an e-Delphi approach.

Methods: A modified electronic Delphi (e-Delphi) process, informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, was conducted over two iterative survey rounds to refine expert perspectives. 60 experts were purposively sampled from oral health, aged care, policy, and implementation science. Quantitative responses were summarized with descriptive statistics, while qualitative feedback was analyzed through reflexive thematic analysis.

Results: Consensus was reached on the importance of mandating oral health care in national aged care accreditation standards, embedding oral health into broader aged care policies and requiring systematic oral health assessments as part of routine care. Participants highlighted workforce shortages, insufficient training, limited practitioner access, and organizational readiness as key barriers. Enablers included workforce development, simplified and standardized assessment tools, mobile and outreach dental services, policy mandates, and cultural change recognizing oral health as integral to person-centered care. Round two resolved areas of initial uncertainty, with consensus achieved on all outstanding items.

Conclusion: This study provides the first consensus-based priorities for embedding oral health assessment tools in RAC, signaling sector-wide readiness for reform. Applying the EPIS framework, the findings highlight that enforceable accreditation standards must be paired with workforce training, oral health champions, and practical tools to ensure sustainable uptake. These insights offer an evidence-informed roadmap for policymakers and service providers, reframing oral health from a peripheral task to a regulated element of clinical governance and quality care.

Objective: This study's goal was to investigate the association between intensive parenting attitudes and topical fluoride opposition.

Methods: This was a secondary analysis of data on caregivers' beliefs about fluoride for their children. An 85-item survey was administered from November 2020 to September 2021 (N = 1135). Participants were eligible if they were an English-speaking caregiver of a child under 18 years. The outcome variable was topical fluoride opposition, defined as how opposed the caregiver was to topical fluoride for their child (self-reported scale of 0-10). The explanatory variable was intensive parenting attitudes, defined as the extent of child-centered, time-intensive, and self-sacrificing parenting, measured through a composite score from three survey items. Linear regression was used to test the study hypothesis, adjusting for confounders. All analyses were performed in SPSS.

Results: The mean ± SD caregiver age was 41.7 ± 8.8 years, with most caregivers being women (73.0%), White (55.5%), non-Hispanic (79.3%), having greater than a 4-year degree (28.5%), and having private dental insurance (45.1%). The mean ± SD topical fluoride opposition score was 2.0 ± 3.1, and the mean ± SD intensive parenting attitudes score was 1.7 ± 0.4. After adjusting for confounders, a 1-point increase in intensive parenting attitudes score was associated with a 0.3-point increase in topical fluoride opposition score (95% CI: 0.1, 0.4; p < 0.001).

Conclusions: Intensive parenting attitudes were significantly and positively associated with topical fluoride opposition. Clinicians can utilize these findings to assess caregivers' intensive parenting attitudes, learn about concerns, and address them by tailoring communication strategies to discuss appropriate risk-based recommendations about topical fluoride.

Objectives: With the growing emphasis on incorporating dental care into universal health coverage (UHC) worldwide, it is essential to understand the extent to which UHC can improve access to needed health services without financial hardship. Dental care services should be included in monitoring progress toward UHC, but are often left out, even in countries with UHC. This study will compare socioeconomics-related inequalities in dental care utilization among older Australians and Japanese, who experience contrasting universal dental insurance systems.

Methods: We used data from Australia and Japan to estimate socioeconomics-related inequalities in dental care utilization as the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) for community-dwelling adults aged 65 years and older. Socioeconomic status was measured using equivalized income and educational attainment. Dental care utilization was defined as visiting a dentist within the past 12 months.

Results: The study included 6104 Australian participants (mean age 73.8 years) and 19,043 Japanese participants (mean age 74.9 years). Income-related inequalities in dental care utilization were higher in Australia [SII (0.22, 95% CI = 0.18-0.27); RII (1.48, 95% CI = 1.36-1.59)] than in Japan [SII (0.16, 95% CI = 0.14-0.19); RII (1.28, 95% CI = 1.24-1.33)]. We found a similar pattern in educational attainment.

Conclusions: Notwithstanding the differences between the two dental care systems, the lack of UHC in dental care in Australia may be a contributing factor to greater inequalities in dental care utilization among older adults.