Ohio dentists’ awareness and incorporation of the dental home concept

BackgroundThe authors measured the awareness of the dental home concept among pediatric dentists (PDs) and general practice dentists (GPs) in Ohio and determined whether they included dental home characteristics for children 5 years and younger into their practices.MethodsThe authors sent a pretested 20-question survey to all Ohio PDs and to a random sample of approximately 20 percent of GPs in Ohio. The authors designed the survey to elicit information about dental home awareness and the extent to which dental home characteristics were incorporated into dental practices.ResultsMore than 90 percent of both GPs and PDs incorporated or intended to incorporate into their dental practices the specific dental home characteristics mentioned in 20 of 41 items related to dental home characteristics. Of the respondents who did not already incorporate dental home characteristics into their practices, however, most did not intend to do so. Less than 50 percent of respondents in both groups responded positively to some items in the culturally effective group, and GPs were less likely than were PDs to provide a range of behavior management services and to provide treatment for patients with complex medical and dental treatment needs. PDs were more likely than were GPs to accept Ohio Medicaid (64 versus 33 percent). PDs were more likely than were GPs (78 versus 18 percent) to be familiar with the term “dental home.” More recent dental school graduates were more familiar with the term.ConclusionsMost Ohio PDs’ and GPs’ practices included characteristics found in the definition of dental home, despite a general lack of concept awareness on the part of GPs. Research is needed to provide an evidence base for the dental home.Practical ImplicationsOnce an evidence base is developed for the important aspects of the dental home and the definition is revised, efforts should be made to incorporate these aspects more broadly into dental practice.     

A Comparison of Medical and Dental Outcomes for Medicaid-Insured and Uninsured Medicaid-eligible Children: A U.S. Population–Based Study

BackgroundIn a population-based study of Medicaid-eligible children, the authors described and compared sociodemographic attributes, medical and dental health care utilization, and health status between Medicaid-insured and uninsured Medicaid-eligible children.MethodsThe authors analyzed data from 2,491 poor Medicaid-eligible children 2 to 16 years of age who participated in the 1999–2004 National Health and Nutrition Examination Survey. They quantified the association of medical and dental health care utilization, health status and treatment needs with Medicaid insurance status by using multivariable logistic regression modeling, taking into account the complex survey design and sample weights.ResultsApproximately 40 percent of Medicaid-eligible children were uninsured. Medicaid-insured children were more likely to have an annual physician visit but no more or less likely to have good general or oral health, asthma or dental caries, or treatment needs than were uninsured Medicaid-eligible children. Medicaid-insured older children (9–16 years old) were more likely to have an annual dentist visit than were uninsured Medicaid-eligible older children.ConclusionsChildren with Medicaid coverage were more likely to use health care services but no more or less likely to have good general health, good oral health, asthma treatment needs or dental treatment needs.Practice ImplicationsTo improve health care use, more poor children need to be enrolled in Medicaid.     

Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid‐eligible children in the United States?

BACKGROUND: Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health. OBJECTIVE: To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children. METHODS: The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights. RESULTS: Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18). CONCLUSIONS: This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.     

Characteristics of Patients Seeking Care from Independent Dental Hygienist Practices

Objectives : This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. Methods : New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. Results : Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. Conclusion : Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.     

Louisiana dentists' attitudes toward the dental Medicaid program.

PURPOSE: This study was performed to determine factors associated with Louisiana dentists' participation in the Dental Medicaid Program. METHODS: Surveys were mailed to all pediatric and general dentists as reported by the Louisiana State Board of Licensing. A second mailing was made to non-respondents. RESULTS: Surveys from 956 of 1,926 dentists (50%) were returned. Of 607 general dentists and 40 pediatric dentists who treated dental Medicaid-enrolled children in the past year, 269 (44%) and 18 (45%), respectively, treated all Medicaid-enrolled children. Newly graduated dentists were more likely to be actively enrolled than their more established counterparts (chi 2 = 10.67; p = 0.01). Medicaid reimbursement levels were viewed as "much less" than private fees by 62%, "less" by 33% and "the same" by 4% of the respondents. Broken appointments were the most prevalent reported problem (80%), followed by low fees (61%), patient non-compliance (59%), unreasonable denial of payments (57%), slow payment (44%), and complicated paperwork (42%). With the exception of the perceived importance of Medicaid reimbursement levels, active and inactive general and pediatric dentists' perceptions of the importance of Medicaid issues were not significantly different. These findings indicated that significantly more Medicaid-active general dentists who allocated 10% of their office visits to Medicaid-eligible children felt that slow payment (p = 0.002) and complicated paperwork (p < 0.001) were more important problems than general dentists who allocated less time to Medicaid-eligible children. CONCLUSIONS: Louisiana dentists' sources of dissatisfaction with Medicaid are similar to those of dentists in other states. Some of the issues are programmatic and are within the power of the dental Medicaid director and state legislature to address. Patient-related issues such as frequent broken appointments may be addressed by assigning case managers to Medicaid beneficiaries.     

Random blood glucose testing in dental practice: a community-based feasibility study from The Dental Practice-Based Research Network

BackgroundThe prevalence of diabetes mellitus (DM) has been increasing. Instances of patients' not having received a diagnosis have been reported widely, as have instances of poor control of DM or prediabetes among patient's who have the disease. These facts indicate that blood glucose screening is needed.MethodsAs part of The Dental Practice-Based Research Network, the authors conducted a study in community dental practices to test the feasibility of screening patients for abnormal random blood glucose levels by means of glucometers and finger-stick testing. Practitioners and staff members were trained to use a glucometer, and they then screened consecutive patients older than 19 years at each practice until 15 patients qualified for the study and provided consent. Perceived barriers to and benefits of blood glucose testing (BGT) were reported by patients and dental office personnel on questionnaires.ResultsTwenty-eight practices screened 498 patients. A majority of the respondents from the 67 participating dental offices considered BGT useful and worth routine implementation. They did not consider duration of BGT or its cost to be significant barriers. Among patients, more than 80 percent thought BGT in dental practice was a good idea and found it easy to withstand; 62 percent were more likely to recommend their dentists to others if BGT was offered.ConclusionBGT was well received by patients and practitioners. These results support the feasibility of implementation of BGT in community dental practices.Clinical ImplicationsImproved diagnosis and control of DM may be achieved through implementation of BGT in community dental practices.     

Professional monopoly, social covenant, and access to oral health care in the United States

Lack of access to oral care is a severe problem in the United States with over one-third of the population lacking dental insurance. In this group, 32 million people lack dental insurance and access to public dental services (Medicaid or Medicare), and 7 million of them need dental care. In some high-risk populations, such as Native Americans, two-thirds have unmet dental needs. Only 1 percent of Medicaid-eligible babies have a dental examination before twelve months of age. In this paper the social covenant of the dental profession is examined and suggestions made for improving access to care through improved efficiency. It is proposed that 1) private dentists should accept 5 percent per annum of their patients for indigent care funded by improved efficiency from utilizing allied dental providers (ADP) in new roles, and 2) ADP should have their own independent state boards. If dentists refuse to honor their social covenant, then ADP should be allowed to practice independently, breaking the professional monopoly.     

Influence of community-based dental education on dental students' preparation and intent to treat underserved populations

This study examined the influence of community-based dental education (CBDE) on dental students' perceived ability to treat underserved patients and their selection of community dental clinics as a first career path. In a 2009 survey, fourth-year dental students at the University of Michigan recorded their attitudes, skill level, and confidence in treating underserved patients before and after CBDE rotations and estimated what percentage of their practice they planned to devote to Medicaid-eligible patients. The first career choices of graduates from 2005 to 2010 were also correlated with the number of weeks the students spent in CBDE rotations. The results showed an improvement in student skill and confidence in treating low-income patients after the rotations. The examination of first career choices showed that, after three to five weeks of CBDE rotations, 5.6 percent of the students planned to practice in a community-based dental clinic. However, in 2009 when rotations were increased to eight weeks and included multiple clinic types, 11.8 percent of the students in 2009 and 16.5 percent in 2010 selected a community-based dental clinic as their preferred practice location. These findings suggest that CBDE improves dental students' skill and confidence level in treating underserved patients and that more time spent in CBDE rotations, specifically more than five weeks in multiple clinic types, may increase the number of graduates who select practice in community-based clinics as a first career choice.     

Preventive oral health behaviors among African-Americans and whites in Detroit

OBJECTIVE: This study compared the preventive oral health behaviors of African-Americans and whites. METHODS: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. RESULTS: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. CONCLUSIONS: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.     

General dentists and pediatric dental patients: the role of dental education

The objective of this study was to investigate whether undergraduate dental education affects general dentists' practice characteristics, attitudes, and professional behavior concerning the treatment of pediatric patients. Data were collected with a self-administered mailed survey from 241 general dentists who were members of the Michigan Dental Association (response rate=48.2 percent). While 40.4 percent of the respondents reported that their dental education had prepared them well to treat child patients, only 33.4 percent indicated that their clinical education had prepared them well. The level of educational preparedness was significantly correlated with a) practice characteristics such as how well the practice was set up to treat children and how knowledgeable and comfortable the staff was concerning providing care for children, b) attitudes concerning the treatment of child patients, and c) professional behavior such as the types of services provided for child patients versus the number of referrals made. The findings strongly suggest that educational experiences concerning the treatment of pediatric dental patients will shape future dental care providers' attitudes and professional behavior. Given the lack of access to dental care for children, it seems crucial to carefully evaluate undergraduate dental curricula to ensure that future dental care providers receive sufficient educational and especially clinical experiences concerning the treatment of child patients.     

Maryland Residents'' Attitudes Toward AIDS and the Use of Dental Services

This project was conducted to examine the impact of Maryland residents' attitudes about AIDS on dental services utilization. A telephone survey of 1,477 households was conducted (response rate 68.9%). Less than 7 percent of the respondents volunteered a concern about contracting AIDS in the dental office. When asked directly, approximately 35 percent stated they would change dentists if their dentist were treating AIDS patients. Respondents who were most aware of the wide-spread treatment of AIDS patients by dentists were more likely to believe their dentist was treating AIDS patients. Also, they were less likely to report that they would leave the practice of dentists with AIDS or those who treated AIDS patients. It is critical for the public to be educated properly about the continued safety of the dental office and to receive accurate information about AIDS.     

Assessing Patterns of Restorative and Preventive Care Among Children Enrolled in Medicaid,by Type of Dental Care Provider

BackgroundThe authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children.MethodsThe authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally.ResultsAmong the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers.ConclusionsThe study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care–only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.     

Knowledge of oral cancer and screening practices of primary care providers at Federally Qualified Health Centers

OBJECTIVES: Primary care providers (PCPs) who worked in Federally-Qualified Health Centers (FQHC) in Michigan were surveyed to assess their knowledge level and practices related to screening and preventing oral cancer. METHODS: A questionnaire was developed with the assistance of dental and medical experts, and revised through focus groups. The questionnaire included one case scenario describing a suspicious oral lesion in a 55-year old female patient, followed by questions assessing PCPs' knowledge level, attitude, opinion, and screening practices for oral cancer. This mail survey was conducted in 2003. RESULTS: Survey response rate was 56.4%. Over 70% of the respondents reported that they screen patients for oral cancer during a routine physical examination. Forty-four percent of PCPs had high knowledge level, based on the scenario questions. Those who had high knowledge level were more likely to be physicians, males, and more likely to perform screening for oral cancer than those with low knowledge level. There was no difference in age and race/ethnicity between high and low knowledge groups. Perceived barriers included (1) lack of education; (2) lack of specialists to refer patients; and (3) lack of reimbursement. CONCLUSIONS: The majority of PCPs in this survey had positive attitudes about performing screening for oral cancer. To involve PCPs in screening for oral cancer, oral health programs should focus on providing up-to-date education, setting up a referral system, and providing proper reimbursement.     

Increasing dental care utilization by Medicaid-eligible children: a dental care coordinator intervention

Objectives: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.
Methods: One hundred and thirty-six children enrolled in Medicaid aged 4 to 15 years at baseline in 2004 who had not had Medicaid claims for 2 years, were randomly assigned to intervention or control groups for 12 months. Children and caregivers in the intervention group received education, assistance in finding a dentist if the child did not have one, and assistance and support in scheduling and keeping dental appointments. All children continued to receive routine member services from the dental plan administrator, including newsletters and benefit updates during the study.
Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.
Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.     

Perception of oral health needs by Southeast Iowa non-dental health care providers

The purposes of this dental study were to identify, among non-dental health care providers and administrators, (1) those reasons assessed to be most persuasive in adopting selected dental preventive practices, (2) barriers perceived to be present for their clients to obtain dental services, and (3) practices which would make dental services more available to their clients. A nine-item dental care/attitude survey was completed by 82% (n = 68) of the health care and social services providers/administrators attending one of the United Way of East Central Iowa group meetings. The results of this survey indicated that, for these respondents, the most persuasive reasons for adopting preventive dental practice behaviors were based on susceptibility to disease and social and esthetic benefits. Further, the results of this survey showed that female respondents gave significantly higher scores than males to the importance of social benefits (self-worth and employment marketability), health benefits, and the importance that authority figures (dentists and physicians) placed on the behavior. Fifty-one percent of the respondents knew of patients who had problems obtaining dental services. The main reasons given for clients' access problems were the lack of money, the lack of insurance, and the lack of transportation.     

Access and utilization of dental services by Alabama Medicaid-enrolled children: a parent perspective

PURPOSE: The purposes of this survey were to assess barriers to utilization of dental services among Medicaid-enrolled Alabama children and identify families who used or did not use Medicaid-covered dental services. METHODS: A random sample of 4,500 parents of Medicaid-eligible children ages 3 to 19 years was surveyed. Participants came from Medicaid enrollment data stratified by area of residence into 3 groups: (1) large urban; (2) town; and (3) rural. Univariate and multivariate analyses were conducted. RESULTS: The overall response rate was 40% (N = 1,766). Most respondents (71%) reported that their child had a dental visit in the past year. Compared to parents who had a dental visit, those who reported no visits were more likely to: (1) be non-Hispanic African American; (2) be less educated; (3) live in rural settings of Alabama; (4) have more children younger than 6 or older than 12; (5) have more children with disabling conditions; and (6) report poor perceived oral health. Respondents with no dental visits were grouped into 3 categories-those who: (1) believed they did not need dental care (46%); (2) thought dental care was hard to find (34%); and (3) tried but could not get dental care (20%). The first group had significantly less respondents with a high school or greater education, more reporting perceived good to excellent oral health, and more living in rural areas, compared to the other 2 groups. CONCLUSIONS: Families who did not use Medicaid-covered dental services include: (1) a group with high perceived need and barriers to care; and (2) a group with little perceived need. Interventions must target both groups.     

Parents' perspectives on a dental home for children with special health care needs

The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.     

Using insurance claims and demographic data for surveillance of children's oral health

OBJECTIVES: This paper examines the utility of using private insurance and Medicaid dental claims as well as demographic data for assessing the oral health of children aged 5-12 years in Genesee County, Michigan, communities. METHODS: Dental insurance claims data from Delta Plan of Michigan and Michigan Medicaid, plus demographic data from the 1990 US Census (percent poverty) and from the 1995 National Center for Educational Statistics (percent free or reduced lunch eligibility), were compared to findings from two school-based oral health surveys. These surveys were the 1995 Genesee County Oral Health Survey and the 1998-2001 Mott Children's Health Center oral health screenings. Data were analyzed using zip codes, representing communities, as the comparison unit. Statistical comparisons using correlation coefficients were used to compare the findings from the six data sets. RESULTS: Using the insurance claims and school-based data, some communities consistently demonstrated high levels of dental caries or treatment for the primary dentition. The demographic measures were significantly associated with many of the primary dentition survey measures. The demographic data were more useful in identifying communities with high levels of dental disease, particularly in the primary teeth, than the insurance claims data. CONCLUSIONS: When screening is not practical, readily available demographic data may provide valuable oral health surveillance information for identification of high-risk communities, but these data do not identify high-risk individuals. In these analyses, demographic data were more useful than dental insurance claims data for oral health surveillance purposes.