Current research in preventive dentistry and its impact on the future of dental care

To my mind, preventive dentistry has not changed all that much in the last 10 to 15 years. No miracle drug has come on the scene to prevent periodontal disease. There is no caries vaccine to eliminate dental caries. Interestingly, it has been the traditional technologies that have, given the advantage of time, proven their potential. The reality seems to have surpassed even our most optimistic expectations. But while we have learned how to effectively implement these technologies in many instances, the promotion of water fluoridation has lagged. Nevertheless, the improvements in oral health speak well of the work of our predecessors, who shaped the world of modern dental care. It is up to the profession to use existing preventive technologies to their best advantage and to devise even better preventive measures for the 20 per cent to 30 per cent of the population who are at highest risk of caries and periodontal disease. This paper has focused on some points of interest that have been published in the dental literature on preventive dentistry. Other issues represent concerns of the author. I invite comment and discussion on the topics and issues that were raised. Dialogue is healthy.     

Methamphetamine abuse: medical and dental considerations

Amphetamines are central nervous system stimulants with high abuse potential and intense physiological and psychological effects. Abuse of methamphetamine--a methyl derivative of amphetamine--has grown to epidemic proportions across the United States. Due to the characteristic signs of methamphetamine abuse that appear in the oral cavity dentists should have a heightened awareness of the medical and dental issues surrounding this dangerous behavior. Moreover, recognition and proper referral to treatment should be a part of every provider's plan for preventing the devastating psychological, oral, and overall systemic effects of methamphetamine abuse.     

Dental insurance and its impact on preventive dental care visits for U.S. children

BACKGROUND: The authors sought to describe the proportion and characteristics of U.S. children with dental insurance and to assess the relationship between dental insurance and preventive dental care (PDC). METHODS: The authors used the National Survey of Children's Health, designed to represent all U.S. children. Outcomes of interest were dental insurance status and at least one PDC visit in the previous year. RESULTS: Seventy-seven percent of U.S. children had dental insurance; of these, 29 percent had public dental insurance. Overall, 16.3 million children lacked dental insurance, 2.6 times the number of children who did not have medical insurance. Children uninsured for dental care were less than half as likely to have received PDC. Among children without dental insurance, 3 million were potentially eligible for public dental insurance and 8 million had private medical insurance but no dental insurance. While the majority of children younger than 3 years had dental insurance, few received PDC (for example, 76 percent of 2-year-olds had dental insurance but less than one-quarter had received PDC). Race/ethnicity was an important modifier in the relationship between insurance coverage and PDC. African-American children, regardless of dental insurance type, were significantly less likely than white children to have received PDC. CONCLUSIONS: Dental insurance, whether public or private, is associated with the receipt of PDC. However, disparities in PDC disproportionately affect young children and black and multiracial children, even those with dental insurance. Despite recent increases in the number of children with dental insurance, 2.6 times as many children did not have dental insurance compared with those who had medical insurance. CLINICAL IMPLICATIONS: The authors offer recommendations to increase the availability of dental insurance to U.S. children.     

The impact of insurance on charges for dental care

This study assesses the effect of insurance on charges for dental care. It is hypothesized that dental practices with higher percentages of insured patients will have higher average charges for dental visits, all other things being equal. An econometric model and ordinary least squares analysis are used to test the hypothesis, based on data from the American Dental Association's 1985 Survey of Dental Practice. For the sake of homogeneity, the study is confined to solo general practitioners. Within this group, the model is applied to two practice types categorized by whether or not the practice employed a hygienist. In solo general practices with and without hygienists, a positive association between the prevalence of insureds within a practice and charges for dental care visits is shown. Hypothetical cases are used to demonstrate that an additional 18 percent of insureds within a practice results in a 6 percent increase in the average charge for a dental visit. The analysis uncovers associations between other variables and dental charges. Of particular note is the curvilinear relation between a dentist's years of experience and his or her charges for dental care.     

The impact of dental Medicaid reform on dental care provider activity and market penetration of dental support organizations

BackgroundMedicaid state dental programs have experienced changes related to provider practice settings with the increased growth of dental support organizations (DSOs). The authors conducted this study to assess the impact of state Medicaid reform on the dental practice environment by examining provider activity and practice setting.MethodsThis was a retrospective cohort study of more than 13 million dental claims in the Virginia Medicaid program. It included children and dental care providers in the Virginia dental Medicaid program at some time during a 9-year period (fiscal years 2003-2011). The independent variable was the provider practice setting: private practice, DSO, and safety-net practice. The outcomes included annual measures of claims, patients, and payments per provider. The outcomes were examined over 3 phases of the study period: prereform (2003-2005), implementation phase (2006-2008), and postreform maturation (2009-2011).ResultsProvider activity increased after dental program reform, with private-practice providers delivering most of the dental care in the Medicaid program. There was a significant penetration of DSO providers in number of providers, claims per provider, and patients per provider (P < .001). Regression results found that providers in DSO settings had an increased number of patients and claims compared with private-practice providers.ConclusionsMedicaid reform has resulted in a significant increase in provider participation and growth of DSO-affiliated providers.Practical ImplicationsAreas of the state with more dense population had a higher penetrance of dentists practicing in DSO settings providing dental services to children enrolled in Medicaid.     

Global antibiotic resistance and its impact on the dental community

There is significant evidence that the global problem of microbial resistance to antibiotics has reached the dental community both in our practices and our family lives. This paper will present a global overview of microbial resistance, discuss how this problem directly affects the dental community, and show what we can do to change the situation, both as concerned citizens and as dental health care practitioners.     

Global antibiotic resistance and its impact on the dental community

There is significant evidence that the global problem of microbial resistance to antibiotics has reached the dental community both in our practices and our family lives. This paper will present a global overview of microbial resistance, discuss how this problem directly affects the dental community, and show what we can do to change the situation, both as concerned citizens and as dental health care practitioners.     

Delta Dental Plans Association; its impact on expanded duties of auxiliaries and the delivery of dental care

Here a Vice President of Delta Dental Service Plans briefly, but forcefully presents the impact of the new Association on the practice of dentistry in this country.     

U.S. predoctoral education in pediatric dentistry: its impact on access to dental care

This study sought to identify faculty, organization, patient pool, and procedures taught in predoctoral pediatric dentistry programs using a questionnaire sent to all fifty-five U.S. dental schools in 2001. Forty-eight (87 percent) programs reported an average of 3.9 full-time and 2.1 part-time FTE faculty, resulting in a mean faculty to student ratio of 1:6.4. One-third employ general dentists to teach pediatric dentistry, and 36 percent report fewer faculty than five years ago. Two-thirds were stand-alone departments. Over half (55 percent) reported increases in patient pools, but also a lack of patients with restorative needs. Half of the programs supplemented school-based pools with special populations, and two-thirds sent students on external rotations, most often to treat high-caries children. Those not using external rotations cited lack of faculty. Accepted patients averaged about four years, with only 6 percent of the pool under three years. Low-income or Medicaid-covered children accounted for 88 percent of school patient pools. Half of the schools felt the pool inadequate to meet competencies, attributable to lack of patients' restorative needs or inadequate intake numbers. Fewer than half of the programs (48 percent) provided hands-on experience with disabled patients, and one-third afforded every student with this experience. Pediatric dentistry was mentioned in fewer than half of the competency documents. Results suggest that U.S. pediatric dentistry predoctoral programs have faculty and patient pool limitations that affect competency achievement and adversely affect training and practice.     

The Mental Capacity Act 2005 and its impact on dental practice

In 1995, the Law Commission was given the task of investigating 'the adequacy of legal and other procedures for decision-making on behalf of mentally incapacitated adults'. It concluded that the law was fragmented and confusing and called for a single statute to govern decision-making on behalf of mentally incapable adults regarding welfare, healthcare and financial matters. There followed a 15 year period of consultation, resulting in the new Mental Capacity Act 2005 which came into full force in October 2007. Dentists who administer treatment to patients suffering from mental incapacity due to dementia, learning disabilities, depression, brain injury and other forms of mental disorder, need to be familiar with the Act and its accompanying Code of Practice. This article looks at how the new Act impacts upon the treatment of incapable patients by dentists, whether they are in general surgery, community or hospital settings. In particular, this article focuses on the provisions of the Act which relate to how and when capacity should be assessed prior to the dentist carrying out treatment and the consequences of a finding of incapacity for both the dentist and the patient in his or her care.     

Anticoagulant therapy and its impact on dental patients: a review

Several new oral anticoagulants have been studied in the past decade, and have now started to enter the market. These drugs are reported to be as effective as, or more effective than, warfarin. In Australia, the Therapeutic Goods Administration has approved dabigatran, rivaroxaban and apixaban. The use of these newer anticoagulants is likely to increase in time, and it is important for dentists to have a sound understanding of the mechanisms of action, reversal strategies, and management guidelines for patients taking oral anticoagulants. This article discusses the process of coagulation, available anticoagulants and their monitoring and reversal, and provides clinical advice on the management of patients on anticoagulants who require dental treatment.     

The impact of the affordable care act's Medicaid expansion on dental care use through 2016

Objective

To examine the impact of the Affordable Care Act on dental care use among low‐income adults ages 21‐64.

Methods

Our analysis uses national survey data from the 2010‐2016 Gallup Wellbeing‐Index. We use a differences‐in‐differences analysis to assess changes since the end of 2013 in dental care use among low‐income adults. We compare changes in states that expanded Medicaid and offer adult Medicaid dental benefits versus changes in other states.

Results

Relative to the pre‐reform period and other states, in Medicaid expansion states with adult dental benefits, dental care use increased 3‐6 percentage points in 2016.

Conclusions

In Medicaid expansion states with adult dental benefits, evidence suggests that low‐income adults have greater access to dental care.