Counseling on Early Childhood Caries transmission by dentists

Objective: High levels of Streptococcus mutans on teeth of young children are predictive of Early Childhood Caries (ECC). Transmission from mother‐to‐child is common and studies have demonstrated treatment of the mother results in less ECC. The objective of this study was to determine how dentists have adopted the practice of counseling about ECC. Methods: In 2006 as part of a larger study on dental care for pregnant women, we surveyed 829 general dentists in Oregon. The questionnaire contained questions to capture the extent to which general dentists have adopted counseling pregnant women about ECC transmission, to describe personal and practice characteristics, and examine how dentists' views on the ease of adopting of new procedures related to ECC counseling. Multivariate logistic regression was used to identify separate and additive effects of demographic and practice characteristics, attitudes, and beliefs. Results: The adjusted odds of a dentist who strongly believed in the link between mothers and babies and provided ECC counseling were 1.60 (95% CI 1.3‐2.0, P < 0.01). The odds of a dentist who reported discussing ECC with staff members and provided counseling were 2.7 (95% CI 1.7‐4.3, P < 0.01). Male dentists were less likely to counsel patients than female dentists (Adjusted OR = 0.5, 95% CI 0.3‐1.0, p < 0.05). Conclusions: The strongest predictors of counseling patients about ECC were dentists' belief in the evidence of caries transmission and dentists' discussion of ECC during staff meetings.     

Providing dental care to pregnant patients: A survey of Oregon general dentists

BackgroundA growing number of studies and reports indicate preventive, routine and emergency dental procedures can be provided safely to pregnant patients to alleviate dental problems and promote oral health of mothers and children.MethodsIn 2006 and 2007, the authors conducted a survey of 1,604 general dentists in Oregon. The survey asked dentists about their attitudes, beliefs and practices regarding dental care for pregnant patients. The authors compared the responses with 2006 guidelines from a New York State Department of Health expert panel.ResultsThe response rate was 55.2 percent. Most respondents (91.7 percent) agreed that dental treatment should be part of prenatal care. Two-thirds of respondents (67.7 percent) were interested in receiving continuing dental education (CDE) regarding the care of pregnant patients. Comparisons of self-reported knowledge and practice with the aforementioned guidelines revealed several points of difference; the greatest regarded obtaining full-mouth radiographs, providing nitrous oxide, administering long-acting anesthetic injections and use of over-the-counter pain medications.ConclusionsDentists need pregnancy-specific education to provide up-to-date preventive and curative care to pregnant patients. The results of the study identified specific skills and misinformation that could be addressed through CDE.Clinical ImplicationsComprehensive dental care provided during pregnancy is needed to ensure the oral health of all women at risk of experiencing pregnancy-specific problems, as well as the prevention of early childhood caries.     

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.     

An analysis of dentists' incomes, 1996-2009

BackgroundThe U.S. economy is beginning to recover from the most significant contraction since the Great Depression. Several sectors, including dentistry, have experienced reduced consumer demand and reduced earnings. Focusing on general practitioners, the authors analyzed trends in various factors that drive dentists' income to identify which of these factors are most important in explaining the recent decline. They then offer their views on future trends in dentists' net income levels.MethodsThe authors used data from a nationally representative survey of dentists maintained by the American Dental Association (ADA) and data from the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey to analyze trends in real gross billings per visit, rates of collection of gross billings, number of visits to a dentist, percentage of the population who visited a dentist, population to dentist ratio and average real practice expenses.ResultsThe authors found that the recent decrease in dentists' net income levels was driven primarily by a decrease in utilization of dental care on the part of the population. Moreover, this decline in dental care use, although most pronounced during the economic downturn, appeared to have started before the downturn began. This suggests that more factors than solely the economic recession are affecting changes in dental care utilization patterns.ConclusionsThe authors' findings suggest that average real net income for dentists may not necessarily recover to prerecession levels once economic conditions in the United States improve. This finding, combined with the potential implications of health care reform for dentistry, causes the authors to believe the future prospects related to dentists' net income levels remain uncertain.     

The effect of training on the use of tobacco-use cessation guidelines in dental settings

BackgroundAn increase in the number of dentists conducting tobacco-use cessation treatment is needed. The authors assessed the effects of high-intensity training (HIT) or low-intensity training (LIT) and reimbursement on general dentists' tobacco-use–related attitudes and treatment behaviors.MethodsThe authors randomly selected 265 dentists in three states and assigned them to one of five groups: HIT workshop groups with and without tobacco-use cessation counseling reimbursement, LIT mailed self-study groups with and without reimbursement or a control group. Outcomes at follow-up were dentists' self-reported tobacco-use–related attitudes and behaviors and patients' reports of dentists' behaviors.ResultsSignificantly more dentists in the intervention groups reported having positive attitudes and behaviors at follow-up than did dentists in the control group. Dentists in the HIT groups, however, reported assessing patients' willingness to quit and assisting them with the quitting process significantly more often than did dentists in the LIT groups. Significantly more patients of dentists in the intervention groups who used tobacco reported receiving advice and assistance from their dentists than did patients of dentists in the control group. Adding reimbursement to HIT or LIT conditions did not provide additional intervention effect.ConclusionDentists trained by means of a workshop or self-study program used components of a recommended guideline more frequently and felt more positive toward tobacco-use cessation counseling than did dentists in the control group.Clinical ImplicationsAlthough the workshop training was more successful than the self-study training, the latter's reach among dentists could have a more significant public health impact. The effect of reimbursement needs further study.     

The effects of insurance carrier market power on dentists and patients

BackgroundMarket power among dental insurance carriers is a carrier's ability to reimburse dentists at rates below what would exist in more competitive areas. Competition among carriers for dentists' participation in their networks protects dentists from highly discounted fees. The authors examined the extent to which dental insurance carriers facing less competition increase fee discounts.MethodsThe authors selected a sample of dentists from listings of general practitioners. They identified 219 metropolitan areas and contacted 11,542 dentists in those areas by mail, telephone or both. A total of 8,017 dentists completed surveys (a response rate of 69.46 percent). The authors' key focus was the possible relationship between carrier market power and the size of the fee discount. The authors compared discounts across metropolitan areas with their differing levels of insurance coverage and carrier market shares.ResultsCarrier market power was directly related to the sizes of fee discounts. The larger discounts were found where there was significant dental insurance coverage and few carriers providing this coverage. Dentists' net incomes were significantly less in areas with larger fee discounts.Conclusions and Practice ImplicationsDental insurance carrier market power leads to increased fee discounts. These higher discounts reduce dentists' earnings. Although the larger discounts may result in lower overall patient costs, this patient benefit is temporary. Ultimately, the number of practicing dentists in these communities will decrease as dentists seek improved practicing conditions elsewhere. This reduction will lead to overall fee increases until the earning potential of dentists is restored.     

A comparison of dental service use among commercially insured women in Minnesota before, during and after pregnancy

BACKGROUND: The authors examined and compared dental services used by women before, during and after pregnancy. METHODS: In their study, the authors combined medical and dental claims data for 3,462 pregnant women in Minnesota with commercial dental insurance who had been pregnant between Jan. 1, 2004, and Dec. 31, 2005. The authors used McNemar pairwise comparisons, with each subject serving as her own control and her use of various dental services before pregnancy as her own baseline, to evaluate and compare the dental services used during and after pregnancy. RESULTS: During pregnancy, subjects' use of several dental services-radiographs, restorative services, third-molar extractions and anesthesia-decreased significantly (P < .001) in comparison with their prepregnancy use. After pregnancy, subjects' use of checkups, radiographs and restorative services showed significant increases (P < .001). CONCLUSIONS: The significant decreases in use of these services during pregnancy and significant increases after pregnancy may suggest that these women and their dentists were using these services only conservatively during pregnancy or postponing their use altogether until after delivery. CLINICAL IMPLICATIONS: This study's findings may provide useful background information to medical and dental providers, health care plan administrators and policymakers as they consider recommendations regarding oral health care for women during pregnancy.     

Expanding Oral Care Opportunities: Direct Access Care Provided by Dental Hygienists in the United States

Dental hygienists expand access to oral care in the United States.BackgroundMany Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs.MethodsPublications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data.ResultsDental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs.ConclusionDental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services.     

The pediatric dental workforce in 2016 and beyond

BackgroundChildhood caries is a major oral and general health problem, particularly in certain populations. In this study, the authors aimed to evaluate the adequacy of the supply of pediatric dentists.MethodsThe authors collected baseline practice information from 2,546 pediatric dentists through an online survey (39.1% response rate) in 2017. The authors used a workforce simulation model by using data from the survey and other sources to produce estimates under several scenarios to anticipate future supply and demand for pediatric dentists.ResultsIf production of new pediatric dentists and use and delivery of oral health care continue at current rates, the pediatric dentist supply will increase by 4,030 full-time equivalent (FTE) dentists by 2030, whereas demand will increase by 140 FTE dentists by 2030. Supply growth was higher under hypothetical scenarios with an increased number of graduates (4,690 FTEs) and delayed retirement (4,320 FTEs). If children who are underserved experience greater access to care or if pediatric dentists provide a larger portion of services for children, demand could grow by 2,100 FTE dentists or by 10,470 FTE dentists, respectively.ConclusionsThe study results suggest that the supply of pediatric dentists is growing more rapidly than is the demand. Growth in demand could increase if pediatric dentists captured a larger share of pediatric dental services or if children who are underserved had oral health care use patterns similar to those of the population with fewer access barriers.Practical ImplicationsIt is important to encourage policy changes to reduce barriers to accessing oral health care, to continue pediatric dentists’ participation with Medicaid programs, and to urge early dental services for children.     

Bridging the dental-medical divide: Case studies integrating oral health care and primary health care

Background

The National Academies of Sciences, Engineering, and Medicine commissioned an environmental scan describing the status of health care integration of oral health and primary care services.

Oral Hygiene Practices and Dental Service Utilization Among Pregnant Women

BackgroundDaily oral hygiene and regular dental visits are important components of oral health care. The authors&apos; objective in this study was to examine women&apos;s oral hygiene practices and use of dental services during pregnancy.MethodsThe authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic information, as well as data on oral hygiene practices and use of dental services during pregnancy. They used χ² and multivariable logistic regression models to assess associations between oral hygiene practice and dental service use during pregnancy and to identify maternal predictor variables.ResultsOf the 599 participants, 83 percent (n = 497) reported brushing once or twice per day. Twenty-four percent (n = 141) reported flossing at least once daily; Hispanic women were more likely to floss than were white or African American women (28 percent [52 of 183] versus 22 percent [54 of 248] versus 19 percent [23 of 121], respectively, P < .001). Seventy-four percent (n = 442) of the participants reported having received no routine dental care during pregnancy. Hispanic women were significantly less likely than were black or white women to receive routine dental care during pregnancy (13 percent versus 21 percent versus 36 percent, respectively, P < .001). The authors found that being older than 36 years, being of Hispanic race or ethnicity, having an annual income of less than $30,000, flossing infrequently and receiving no dental care when not pregnant were significantly associated with lack of routine dental care during pregnancy (adjusted odds ratios, 95 percent confidence intervals: 2.56 [1.33–4.92]; 2.19 [1.11–4.29]; 2.02 [1.12–3.65]; 1.86 [1.13–3.07]; and 4.35 [2.5–7.69], respectively). A woman&apos;s lack of receiving routine dental care when not pregnant was the most significant predictor of lack of receiving dental care during pregnancy.ConclusionRacial, ethnic and economic disparities related to oral hygiene practices and dental service utilization during pregnancy exist.Clinical ImplicationsMedical and dental care providers who treat women of reproductive age and pregnant women need to develop policy strategies to address this population&apos;s access barriers to, and use of, dental care services.     

Oral health in pregnancy: educational needs of dental professionals and office staff

Objective: Dental care during pregnancy is important for pregnant women and their children. Comprehensive guidelines for the provision of dental services for pregnant patients were published in 2006, but there is relatively little information about their use in actual practice. The aim of this study was to examine differences in knowledge and attitudes regarding dental care in pregnancy among dentists, dental hygienists, dental assistants, and nonclinical office staff. A secondary aim was to identify sources of influence on attitudes and knowledge regarding the guidelines. Methods: A survey was used to collect information from 766 employees of a Dental Care Organization based in Oregon; responses from 546 were included in the analyses reported here. Results: Statistically significant differences in knowledge were found among the professional‐role groups. Dentists and hygienists consistently answered more items correctly than did other respondents. Within all professional‐role groups, knowledge gaps existed and were most pronounced regarding provision of routine and emergency services. Positive perceptions of providing dental care during pregnancy were associated with higher knowledge scores (z = 4.16, P < 0.001). Conclusions: Updated dental education and continuing education for all dental office personnel are needed to promote the diffusion of current evidence‐based guidelines for dental care during pregnancy.     

How willing are dentists to treat young children?: A survey of dentists affiliated with Medicaid managed care in New York City, 2010

BackgroundDespite recommendations for children to have a dental visit by the age of 1 year, access to dental care for young children, including children enrolled in Medicaid, remains limited. The authors conducted a survey to assess the availability of dentists to see young children enrolled in Medicaid managed care (MMC) in New York City (NYC), to determine barriers to the provision of dental care to young children and, within the context of MMC, to identify strategies to facilitate the delivery of dental care to children.MethodsThe authors mailed a survey to assess the provision of dental services to young children and perceived barriers and facilitators to 2,311 general dentists (GDs) and 140 pediatric dentists (PDs) affiliated with NYC MMC. A total of 1,127 surveys (46 percent) were received. The authors analyzed the responses according to provider type, youngest aged child seen, provider’s ability to see additional children and practice location. The authors compared responses by using the χ² test.ResultsFewer than one-half (47 percent) of GDs saw children aged 0 through 2 years. Provider type, years in practice and percentage of Medicaid-insured patients were associated significantly (P χ .005) with youngest age of child seen. Among respondents seeing children aged 0 through 2 years, PDs were significantly more likely to provide preventive therapy (P = .004) and restorative treatment (P χ .001). Additional training and access to consulting PDs were identified by GDs as potential facilitators to seeing young children.ConclusionA high proportion of NYC GDs affiliated with MMC do not see young children.Practice ImplicationsNinety-four percent of NYC MMC– affiliated dentists are GDs, but 53 percent of GD respondents did not see children aged 0 through 2 years in their practices. Improving access to dental care for young children requires changes in GDs’ practices, possibly by means of additional training and access to consulting PDs.     

Variations in self-reported provision of services by general dentists in private practice

BackgroundVariations in dentists&;apos; provision of services have been documented, but information about contributing factors is limited.MethodsThe authors used responses to a 2003 survey of general dentists in private practice in California (46 percent response rate; 3,098 dentists included in the final sample) to assess variations in service provision and its correlates. They used logistic regressions to assess the correlation of various characteristics with the self-reported percentage of time spent providing services.ResultsThe results show variations in services provided by general dentists in private practice. Multiple factors, including the dentist&;apos;s sex, region of practice, employment of hygienists, patients&;apos; race and population income in the area of practice were significantly and independently associated with provision of services.ConclusionsThe survey results reflect practice variations that existed before the latest economic downturn, which resulted in a loss of jobs and medical and dental insurance. The data serve as the baseline for future studies of changes in dental practice and for assessing the impact of the 2010 health care reform legislation on dental practice.Practice ImplicationsImprovements in oral health care, the recent economic decline and health care reform may lead to changes in dental practice and in the dental workforce.     

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.     

Preventing dentists' involvement in torture: The developmental history of a new international declaration

BackgroundFor more than half a century, the risk of physicians participating in torture has received thoughtful attention in the field of medicine, and a number of international organizations have issued declarations decrying such involvement. Despite publications that provide evidence of dentists' having participated in torture as well, until recently the dental profession was quiescent on the subject.MethodsThe authors describe the historical background for a new declaration against dentists' participation in torture developed by the International Dental Ethics and Law Society and the Fédération Dentaire Internationale (FDI) World Dental Federation. They review various levels of involvement by dentists in torture and related activities in reference to existing World Medical Association declarations. Finally, they outline the process of drafting the new dental declaration, which was adopted by the FDI in October 2007.Clinical ImplicationsThe authors provide insight and guidance to clinicians who diligently serve their patients, unaware that they may face military or other pressures to participate in torture.     

Dentists’ levels of evidence-based clinical knowledge and attitudes about using pit-and-fissure sealants

BackgroundAlthough the prevalence of pit-and-fissure sealants in children in the United States is low, the problem is magnified in low-income children. A small proportion of Florida's low-income children receive any preventive dental services, including sealants. The authors conducted a cross-sectional study to assess whether Florida's dentists provide sealants as a preventive measure in their practices, their attitudes and their levels of evidence-based clinical knowledge about appropriate sealant use according to the American Dental Association (ADA) recommendations. The authors also assessed whether the number of years since graduation and reliance on peers or colleagues for regular clinical information were associated with dentists’ knowledge.MethodsThe authors administered a 25-item pretested questionnaire to a convenience sample of general and pediatric dentists (n = 163) at the 2013 Florida National Dental Convention in Kissimmee, Fla. The authors conducted multivariate linear regression modeling to predict dentists’ levels of evidence-based clinical knowledge.ResultsYears since graduation (P = .2) and reliance on peers or colleagues for regular clinical information (P = .6) did not predict higher knowledge. Male dentists (P = .003) and those who accepted children enrolled in Medicaid as new patients (P = .01) had significantly more knowledge compared with their counterparts.ConclusionsMost participating dentists used sealants in their practices and had high levels of positive attitudes about using sealants. Overall knowledge regarding the appropriate use of sealants, however, was low.Practical ImplicationsFor practicing dental professionals, the authors recommend disseminating evidence-based recommendations for the use of dental sealants via continuing education courses and other possible modalities. They also recommend that dental schools update their existing courses or modules about sealants by integrating the ADA's recommendations.     

Dentists' familiarity with tobacco cessation programs in dental settings in Iran

Objectives: The current study assessed Iranian dentists' practice, knowledge, perceived barriers, and attitudes toward helping patients to quit. We hypothesized that Iranian dentists would have limited knowledge and awareness of tobacco cessation methods or of their important role in encouraging patients to quit. We expected the combination of quantitative and qualitative research to yield important insights regarding effective methods of engaging Iranian dentists in tobacco intervention. Methods: From a list of registered dentists following an initial screening, we randomly selected a total of 1,000 dental practices in 10 randomly selected provinces. Following an initial letter describing the study, we mailed a questionnaire. For the qualitative part of the study, we used a convenience purposeful sampling of 16 dentists. Results: Despite repeated contacts, only 35 percent of those contacted returned completed surveys. Key findings not only included generally positive attitudes toward tobacco cessation programs, but also identification of major barriers including concerns about patient resistance, lack of supportive organization, and opportunities for training. Dentists were far more likely to ask patients about smoking than to provide actual cessation support. Female dentists were more likely to ask patients. The qualitative interviews shed further light on barriers to intervention. Conclusions: Interpretation of the findings is limited by the relatively low response rate. However, despite identified barriers to intervention, we are encouraged by dentists' overall knowledge and interest in tobacco cessation services. We plan to use the current findings to inform development of continuing education programs and incorporation of tobacco cessation counseling into dental school curricula in Iran.     

Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska

BackgroundThe goal of the study was to identify secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, the first area of the United States to authorize dental therapy practice.MethodsElectronic health record transactions from the Yukon-Kuskokwim Health Corporation from 2006 through 2015 (n = 27,459) were analyzed. Five types of dental services were identified using Current Dental Terminology procedure codes: diagnostic, preventive, restorative, endodontic, and oral surgery. Main outcomes were percentages of services provided by dental therapists compared with dentists and population-level preventive oral health care.ResultsThe overall number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta increased. For diagnostic services, there was a 3.5% annual decrease observed for dentists and a 4.1% annual increase for dental therapists (P < .001). Similar trends were observed for restorative services. For preventive services, there was no change for dentists (P = .89) and a 4.8% annual increase for dental therapists (P < .001). Dental therapists were more likely than dentists to provide preventive care at the population level.ConclusionsDental therapists have made substantial contributions to the delivery of dental services in Alaska Native communities, particularly for population-based preventive care.Practical ImplicationsThe study’s findings indicate that there is a role for dental therapy practice in addressing poor access to oral health care in underserved communities.