Association between periodontal care and hospitalization with acute myocardial infarction

BackgroundEach year there are 800,000 myocardial infarctions in the United States. There is an increased risk of hospitalization for acute myocardial infarction (AMI) for those with periodontal disease. Yet, there is a paucity of knowledge about downstream care of AMI and how this varies with periodontal care status. The authors' aim was to examine the association between periodontal care and AMI hospitalization and 30 days after acute care.MethodsUsing the MarketScan database, the authors conducted a retrospective cohort study among patients with both dental insurance and medical insurance in 2016 through 2018 who were hospitalized for AMI in 2017.ResultsThere were 2,370 patients who had dental and medical coverage for 2016 through 2018 and received oral health care in 2016 through 2017 and had an AMI hospitalization in 2017. Forty-seven percent received regular or other oral health care, 7% received active periodontal care, and 10% received controlled periodontal care. More than one-third of patients (36%) did not have oral health care before the AMI hospitalization. After adjusting for patient characteristics, we found that patients in the controlled periodontal care group were significantly more likely to have visits during the 30 days after AMI hospitalization (adjusted odds ratio, 1.63; 95% CI, 1.07 to 2.47; P = .02).ConclusionsWe found that periodontal care was associated with more after AMI visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes.Practical ImplicationsNeeding periodontal care is associated with more favorable outcomes related to AMI hospitalization. Early intervention to ensure stable periodontal health in patients with risk factors for AMI could reduce downstream hospital resource use.     

Impact of disability diagnosis on dental care use for adults in the United States: Status matters

BackgroundApproximately 25% of adults in the United States have a disability that limits function and independence. Oral health care represents the most unmet health care need. This population has been found to have decreased oral health outcomes compared with the general population.MethodsThe authors used the 2018 adult National Health Interview Survey to assess the association between disability status and dental care use (dental visit within or > 2 years). Disability status was categorized as adults with an intellectual, acquired, or developmental disability (IADD) that limits function, other disability that limits function, or no disability, on the basis of diagnoses of birth defect, developmental diagnosis, intellectual disability, stroke, senility, depression, anxiety, or emotional problem, all causing problems with function.ResultsAdults with an IADD with functional and independence-limiting disabilities experienced higher crude odds of going 2 years or more without a dental visit than adults without disabilities (odds ratio [OR], 2.29; 95% CI, 1.96 to 2.67). This association was part of a significant interaction and was stronger among those with IADDs who could afford oral health care (OR, 1.73; 95% CI, 1.47 to 2.14) than among those who could not afford oral health care (OR, 1.21; 95% CI, 0.88 to 1.67; P value of interaction <.01).ConclusionsAdults with IADDs have decreased access to oral health care compared with adults with other disabilities or without disabilities. The inability to afford oral health care lessens the impact of disability status.Practical ImplicationsDentists can use this study to understand the implications of IADD diagnoses on dental care use and make efforts to facilitate care for these patients.     

Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid

BackgroundReducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children’s dental care use, including the association with children’s oral health.MethodsA cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means.ResultsThe 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33).ConclusionsIt was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship.Practical ImplicationsOral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children’s oral health.     

Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure

BackgroundThe objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children.MethodsThe authors examined 2018-2019 National Survey of Children’s Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold.ResultsChildren with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047).ConclusionsTSE in children is associated with caries and inadequate oral health care visits.Practical ImplicationsThe pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children’s teeth condition and increase oral health care visits.     

Effects of the COVID-19 pandemic on children’s oral health and oral health care use

BackgroundThe COVID-19 pandemic led to early restrictions on access to oral health care and social distancing requirements. The authors examined the early effects of the COVID-19 pandemic on children’s oral health and access to oral health care in the United States.MethodsUsing nationally representative data from the National Survey of Children’s Health, the authors compared several measures of children’s oral health and oral health care use early during the pandemic in 2020 with 1 year earlier. Logistic (multinomial or binary) regression models were estimated, adjusting for several child and household covariates and state fixed effects. Similar comparisons were estimated for 2019 relative to 2018 to evaluate prepandemic trends.ResultsChildren in 2020 were 16% (relative risk ratio, 0.84; 95% CI, 0.75 to 0.93) less likely to have excellent dental health as perceived by parents and 75% (relative risk ratio, 1.75; 95% CI, 1.14 to 2.67) more likely to have poor dental health than in 2019. In addition, children in 2020 had higher risk of bleeding gingivae (odds ratio, 1.46; 95% CI, 1.16 to 1.85). The likelihood of having a dental visit in the past 12 months was 27% (odds ratio, 0.73; 95% CI, 0.65 to 0.82) lower in 2020, including lower likelihood for preventive visits. The differences between 2020 and 2019 were observed across demographic and socioeconomic subgroups. There were no such differences between 2019 and 2018.ConclusionsThere was a widespread decline in children’s oral health status and access to oral health care early during the COVID-19 pandemic.Practical ImplicationsPrompt policies and oral health campaigns are needed to counter the pandemic effects and increase timely access to dental services.     

Factors associated with cost conversations in oral health care settings

BackgroundPatient–provider cost conversations can minimize cost-related barriers to health, while improving treatment adherence and patient satisfaction. The authors sought to identify factors associated with the occurrence of cost conversations in dentistry.MethodsThis was a cross-sectional study using data from an online, self-administered survey of US adults who had seen a dentist within the past 24 months at the time of the survey. Multivariable hierarchical logistic regression analysis was used to identify patient and provider characteristics associated with the occurrence of cost conversations.ResultsOf the 370 respondents, approximately two-thirds (68%) reported having a cost conversation with their dental provider during their last dental visit. Cost conversations were more likely for patients aged 25 through 34 years (odds ratio [OR], 2.84; 95% CI, 1.54 to 5.24), 35 through 44 years (OR, 3.35; 95% CI, 1.50 to 7.51), and 55 through 64 years (OR, 3.39; 95% CI, 1.38 to 8.28) than patients aged 18 through 24 years. Cost conversations were less likely to occur during visits with dental hygienists than during visits with general or family dentists (OR, 0.25; 95% CI, 0.11 to 0.58). In addition, respondents from the South (OR, 1.90; 95% CI, 1.04 to 3.48) and those screened for financial hardship were more likely to report having cost conversations with their dental providers (OR, 6.70; 95% CI, 2.69 to 16.71).ConclusionsWithin the study sample, cost conversations were common and were facilitated via financial hardship screening.Practical ImplicationsModifying oral health care delivery processes to incorporate financial hardship screening may be an effective way to facilitate cost conversations and provision of patient-centered care.     

Translating periodontal data to knowledge in a learning health system

BackgroundA learning health system (LHS) is a health system in which patients and clinicians work together to choose care on the basis of best evidence and to drive discovery as a natural outgrowth of every clinical encounter to ensure the right care at the right time. An LHS for dentistry is now feasible, as an increased number of oral health care encounters are captured in electronic health records (EHRs).MethodsThe authors used EHRs data to track periodontal health outcomes at 3 large dental institutions. The 2 outcomes of interest were a new periodontitis case (for patients who had not received a diagnosis of periodontitis previously) and tooth loss due to progression of periodontal disease.ResultsThe authors assessed a total of 494,272 examinations (new periodontitis outcome: n = 168,442; new tooth loss outcome: n = 325,830), representing a total of 194,984 patients. Dynamic dashboards displaying performance on both measures over time allow users to compare demographic and risk factors for patients. The incidence of new periodontitis and tooth loss was 4.3% and 1.2%, respectively.ConclusionsPeriodontal disease, diagnosis, prevention, and treatment are particularly well suited for an LHS model. The results showed the feasibility of automated extraction and interpretation of critical data elements from the EHRs. The 2 outcome measures are being implemented as part of a dental LHS. The authors are using this knowledge to target the main drivers of poorer periodontal outcomes in a specific patient population, and they continue to use clinical health data for the purpose of learning and improvement.Practical ImplicationsDental institutions of any size can conduct contemporaneous self-evaluation and immediately implement targeted strategies to improve oral health outcomes.     

Periodontal treatment associated with decreased diabetes mellitus–related treatment costs: An analysis of dental and medical claims data

BackgroundDiabetes mellitus (DM) and periodontal disease have a suggested bidirectional relationship. Researchers have reported decreases in DM-related health care costs after periodontal treatment. The authors examined the relationship between periodontal disease treatment and DM health care costs in commercial insurance and Medicaid claims data.MethodsThis study of IBM MarketScan commercial insurance and Medicaid databases included overall outpatient, inpatient, and drug costs for patients with DM. The authors examined associations between overall health care costs per patient in 2019 according to use of periodontal services from 2017 through 2018 using generalized linear modeling. The average treatment effect on treated was calculated by means of propensity score matching using a logistic model for periodontal treatment on covariates.ResultsFor commercial insurance enrollees, periodontal treatment was associated with reduced overall health care costs of 12% compared with no treatment ($13,915 vs $15,739; average treatment effect on treated, –$2,498.20; 95% CI, –$3,057.21 to –$1,939.19; P < .001). In the Medicaid cohort, periodontal treatment was associated with a 14% decrease in costs compared with patients with DM without treatment ($14,796 vs $17,181; average treatment effect on treated, –$2,917.84; 95% CI, –$3,354.48 to –$2,480.76; P < .001). There were no significant differences in inpatient costs (commercial insurance) or drug costs (Medicaid).ConclusionsUndergoing periodontal treatment is associated with reduced overall and outpatient health care costs for patients with DM in Medicaid and commercial insurance claims data. There were no significant differences in inpatient costs for commercial insurance enrollees or in drug costs for Medicaid beneficiaries.Practical ImplicationsA healthy mouth can play a key role in DM management. Expanding Medicaid benefits to include comprehensive periodontal treatment has the potential to reduce health care costs for patients with DM.     

Patient-reported receipt of oral cancer screenings and smoking cessation counseling from US oral health care providers: National Health and Nutrition Examination Survey, 2015-2016

BackgroundOral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers.MethodsThe authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office.ResultsOverall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline.ConclusionsOral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers.Practical ImplicationsPotential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.     

Preventive oral health care use for children with special health care needs aged 6 through 12 years enrolled in Medicaid: A mixed methods study

BackgroundThe authors aimed to assess preventive oral health care (POHC) use for children with special health care needs (CSHCN) aged 6 through 12 years enrolled in Medicaid and identify intervention strategies to improve oral health.MethodsIn this sequential mixed methods study, the authors analyzed 2012 Medicaid data for children aged 6 through 12 years in Washington state. They used eligibility and claims data to identify special health care needs status (independent variable) and POHC use (outcome variable). They ran modified Poisson regression models to generate prevalence rate ratios. They coded data from 21 key informant interviews deductively using content analytic techniques.ResultsOf the 208,648 children in the study, 18% were identified as CSHCN and 140,468 used POHC (67.3%). After adjusting for confounding variables, the authors found no difference in POHC use by special health care need status (prevalence rate ratio, 1.00; 95% CI, 0.99 to 1.01; P = .91). In the qualitative analysis, the authors identified 5 themes: caries risk depends on a child’s specific health condition, caries complicates overall health, having a special need creates a bigger barrier to care, legislation alone is “not going to make much of a dent,” and improvements across all fronts are needed to promote the oral health of CSHCN in Medicaid.ConclusionsCSHCN enrolled in Medicaid are just as likely as children without special health care needs to use POHC, although barriers to oral health care access persist for CSHCN.Practical ImplicationsFuture efforts should focus on comprehensive strategies that address the varying levels of dental disease risk and difficulties accessing oral health care within the diverse group of CSHCN.     

Caries risk and social determinants of health: A big data report

BackgroundOral health is influenced by social determinants of health (SDH), predisposing people and communities to greater risk of developing caries. This study evaluated the association between caries risk in adults and SDH such as ZIP Codes, systemic diseases, payment methods, and race or ethnicity.MethodsThe BigMouth Dental Data Repository (n = 57,211) was used to extract clinical and SDH data from patients’ dental electronic health records for 2019. Caries risk categories were used as ZIP Code data was merged with the Social Deprivation Index, a composite measure of area-level deprivation based on 7 demographic characteristics collected in the American Community Survey.ResultsThe results showed that the odds of being in the high caries risk group were higher for people in the 49- to 64-year age group (adjusted odds ratio [aOR], 2.24; 95% CI, 2.08 to 2.40; P ≤ .001), men (aOR, 1.19; 95% CI, 1.13 to 1.25; P ≤ .001), people who had comorbidities (diabetes: aOR, 1.16; 95% CI, 1.08 to 1.24; P ≤ .001; cardiovascular disease: aOR, 1.40; 95% CI, 1.32 to 1.50), and people with an Social Deprivation Index score above the 75th percentile (aOR, 2.39; 95% CI, 2.21 to 2.58; P ≤ .001). In addition, Hispanic and Black people had higher odds of being at high caries risk than other races or ethnicities (Hispanic: aOR, 3.05; 95% CI, 2.32 to 4.00; Black: aOR, 2.05; 95% CI, 1.02 to 4.01).ConclusionsThis study shows the association of caries risk with higher social deprivation, reinforcing the role of structural and upstream factors in oral health. This study is unique in using recorded ZIP Code information and assessing caries risk levels for those regions.Practical ImplicationsThe physical and structural environment should be considered contributors to caries risk in people.     

Comprehensive oral care improves treatment outcomes in male and female patients with high-severity and chronic substance use disorders

BackgroundUsing data from a workforce training program funded by the Health Resources and Services Administration, the authors de-identified pre- and posttreatment assessments of high-severity and chronic substance use disorders (SUDs) to test the effect of integrated comprehensive oral health care for patients with SUDs on SUD therapeutic outcomes.MethodsAfter 1 through 2 months of treatment at a SUD treatment facility, 158 male self-selected (First Step House) or 128 randomly selected sex-mixed (Odyssey House) patients aged 20 through 50 years with major dental needs received integrated comprehensive dental treatment. The SUD treatment outcomes for these groups were compared with those of matched 862 male or 142 sex-mixed patients, respectively, similarly treated for SUDs, but with no comprehensive oral health care (dental controls). Effects of age, primary drug of abuse, sex, and SUD treatment facility–influenced outcomes were determined with multivariate analyses.ResultsThe dental treatment versus dental control significant outcomes were hazard ratio (95% confidence interval [CI]) 3.24 (2.35 to 4.46) increase for completion of SUD treatment, and odds ratios (95% CI) at discharge were 2.44 (1.66 to 3.59) increase for employment, 2.19 (1.44 to 3.33) increase in drug abstinence, and 0.27 (0.11 to 0.68) reduction in homelessness. Identified variables did not contribute to the outcomes.Conclusions and Practical ImplicationsImprovement in SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health care of major dental problems significantly improves treatment outcomes in patients whose disorders are particularly difficult to manage, such as patients with SUDs.     

Oral disorders associated with the experience of verbal bullying among Brazilian school-aged children: A case-control study

BackgroundDental features have been considered a potential target of verbal bullying (VB) among school-aged children. The authors conducted a study to investigate the association between the presence of oral disorders and the occurrence of VB among 8- through 10-year-old school-aged children.MethodsThe study included 445 school-aged children 8 through 10 years old. VB was verified by a specific validated question from the Child Perceptions Questionnaire 8-10 index. Oral disorders such as untreated caries, fluorosis, clinical consequences of untreated caries, and malocclusion were evaluated. The Pearson χ² test and bivariate and multivariate conditional logistic regression analyses were used for statistical analysis.ResultsA total of 390 school-aged children completed the study. The results of the multivariate logistic regression model showed that a severe malocclusion (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.03 to 5.10), a greater maxillary misalignment (OR, 2.23; 95% CI, 1.05 to 4.73), and the presence of a tooth with pulp exposure (OR, 2.93; 95% CI, 1.58 to 5.45) were significantly associated with the occurrence of VB.ConclusionChildren aged 8 through 10 years with a severe malocclusion, larger maxillary misalignment, or the presence of pulp exposure had increased odds of experiencing VB compared with children without those oral health conditions.Practical ImplicationsOnce oral disorders involved in VB are identified, appropriate approaches should be used to address this issue. With this course of action, oral health care professionals may use the treatment and preventive care to eliminate potential factors for peer aggression.     

Screening testing in health care: Getting it right

BackgroundThere is a movement to engage oral health care professionals in administering tests to identify people at risk of developing contagious diseases and other medical conditions. The purpose of this overview was to provide clinicians with fundamental concepts to understand how to evaluate a screening test’s capability to give a correct result and its implications for practice (health outcomes).Types of Studies ReviewedThe authors reviewed epidemiologic and statistical articles addressing the purpose of performing screening tests for medical conditions with a special emphasis on understanding and interpreting test results on the basis of specific test characteristics.ResultsTests with different sensitivities and specificities will provide different probabilities of correctly classifying people with or without a disease of interest. By understanding how to interpret tests results and how to communicate the consequences (that is, impact on health outcomes) of positive and negative test results, oral health care professionals will be able to generate appropriate medical referrals and determine the need for further testing, as well as provide a public service.Conclusions and Practical ImplicationsAn understanding by oral health care professionals of how to interpret screening test results will benefit their patients substantially and, in the case of contagious diseases, the public at large.     

Emergency department visits for infectious oral conditions in Massachusetts, 2014 through 2018

BackgroundThe authors aimed to measure population-based preventable emergency department (ED) visits related to infectious oral conditions (IOCs) in Massachusetts and to examine the associated sociodemographic factors to support prevention efforts.MethodsA statewide retrospective analysis of ED visits related to IOCs in Massachusetts from 2014 through 2018 was conducted using a Center for Health Information and Analysis database. The authors described patients' characteristics, dental diagnoses frequencies, emergency severity, lengths of stay, associated treatment, and costs. Multilevel logistic regression was used to assess factors associated with IOC visits.ResultsIOC visits in 2014 through 2018 were 1.2% (149,777) of the total ED visits, with an estimated cost of $159.7 million. There was an annual decline in the prevalence of IOC visits from 2014 through 2018. After adjusting for sociodemographic factors, odds of IOC were higher among males (adjusted odd ratio [AOR], 1.26; 95% CI, 1.24 to 1.27), non-Hispanic Blacks compared with non-Hispanic Whites (AOR, 1.03; 95% CI, 1.02 to 1.06), people residing in dental health care professional shortage areas (AOR, 1.06; 95% CI, 1.04 to 1.07), public insurance beneficiaries (AOR, 1.90; 95% CI, 1.87 to 1.93), or uninsured (AOR, 2.60; 95% CI, 2.54 to 2.66) compared with privately insured.ConclusionsThere was an annual decline in the prevalence of IOC visits from 2014 through 2018. Higher odds of IOC visits were associated with young adults, Black patients, uninsured people, public insurance beneficiaries, and people who reside in dental health care professional shortage areas.Practical ImplicationsThe authors provided statewide data to support proposed policies to improve oral health care in Massachusetts. IOCs are mostly preventable, but well-coordinated care between medicine and dentistry is integral for prevention.     

Accuracy of parent-reported health history in a dental setting

BackgroundObtaining thorough documentation of a patient’s medical history is important for dental care professionals, as oral health is connected intricately to systemic health. The purpose of this study was to assess the accuracy of parent-reported health history for pediatric patients in a dental setting.MethodsA retrospective chart review was conducted on 863 patients 17 years and younger. Parent-reported health history was compared with subsequent physician-to-dentist consultations. The most common diagnoses were grouped on the basis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, categories.ResultsThe sensitivity of parent report of health conditions was highest for reporting mental and behavioral disorders (75.1%; 95% CI, 69.6% to 80.0%), followed by nervous system diseases (63.0%; 95% CI, 47.5% to 76.8%), respiratory conditions (47.9%; 95% CI, 37.6% to 58.4%), congenital conditions (46.3%; 95% CI, 30.7% to 62.6%), and cardiovascular conditions (25.0%; 95% CI, 11.4% to 43.4%) and was lowest for hematologic conditions (12.2%; 95% CI, 4.1% to 26.2%). Parents of children 6 years and older and those with private insurance had higher sensitivity for reporting mental and behavioral conditions than those with children younger than 6 years or having Medicaid (P < .0001). The specificity of parent-reported health conditions ranged from 96.0% for mental and behavioral disorders to 99.8% for hematologic conditions.ConclusionsSensitivity varied widely, showing that parents may be unreliable in their report of children’s health histories and that dentists cannot rely solely on parents when obtaining health history.Practical ImplicationsIn advocating for patient safety, especially for those with special needs and complex medical conditions, this study supports the use of medical evaluation before dental treatment and for the integration of dental and electronic health records.     

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

BackgroundAlthough disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors’ knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being.MethodsThe authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy.ResultsWomen reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities.ConclusionsMaternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy.Practical ImplicationsGiven the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.     

Oral health needs among youth with a history of foster care: A population-based study

BackgroundChildren and youth in foster care are considered to have special health care needs, including oral health care needs. This study compares the self-identified oral health care needs and access to oral health care among youth who have and have not experienced foster care.MethodsData were drawn from the 2019 Minnesota Student Survey, a statewide survey of public school students in the 5th, 8th, 9th, and 11th grades (N = 169,484). Youth with a history of foster care (3%) were compared with youth with no history of foster care for 7 oral health indicators.ResultsYouth with a history of foster care reported more oral health problems and less access to oral health care than their peers with no history of foster care. Using logistic regression to control for key covariates, the odds of an oral health problem for youth with a history of foster care were 1.54 higher (95% confidence interval, 1.44 to 1.65) than for their peers.ConclusionsYouth with a history of foster care report more oral health problems than their peers. Dentists should recognize the oral health concerns of these youth in the context of their special health care needs and be prepared to render appropriate care. Future studies should explore barriers to oral health care among this vulnerable population.Practical ImplicationsYouth in foster care have self-identified oral health care needs that should be assessed by dental professionals.     

Delivery and financing of oral health care in long-term services and supports: A scoping review

BackgroundThe oral health of older adults requiring long-term services and supports is reported to be poor as there is no national standard of care for the provision of oral health care. The purpose of this scoping review was to understand the breadth of models of delivery and financing of oral health care in the full spectrum of long-term services and supports.Types of Studies ReviewedA literature search was performed in 4 electronic databases: MEDLINE via PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Included articles were those that were regarding a nursing home population or dependent older adults living in the community, included a delivery or financing model for oral health care, and included an outcome measurement.ResultsSixteen articles were included in the review. Delivery mechanisms included onsite mobile oral health care at nursing homes and adult day health care centers for those living in the community or home visits for those who were homebound. Other mechanisms included teledentistry or using alternative workforce models such as certified public health dental hygienists. Numerous studies reported positive oral health outcomes when comprehensive care was provided in a variety of settings. Other reported outcomes included oral health stability, caries indexes, cost, and oral health–related quality of life.Conclusions and Practical ImplicationsIf providing onsite oral health care is not possible at facilities, programs can consider home visits, teledentistry, and alternative workforce models.