Demand for dental services has been known to be linked closely to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to COVID-19 thus may have a ...significant impact on dental care use.
Using deidentified dental practice management data from 2019 and 2020, the authors observed variations in dental care use among insured patients since the COVID-19 outbreak (during the period of practice closure and after the reopening) by patient age, procedure type, insurance type, practice size, geographic area, and reopening status. The authors examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models.
Although dental care use among privately insured patients fully rebounded by August 2020, use still remained lower than the prepandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased 60-fold during practice closure. Geographic characteristics—such as median household income, percentages of rural or Black populations, and dental care professional shortage designations—were associated significantly with the number of procedures performed at dental practices.
As a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particularly among patients covered by public insurance or residing in underserved areas.
During economic downturns, state health officials should be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or midlevel dental care providers in underserved areas.
To examine the association of diabetes with tooth loss and oral manifestations among adult health center patients (HCPs).
This cross-sectional study utilized the nationally representative 2014 ...HCPs-Survey. Descriptive and logistic regression analyses limited to adults (n = 5524) were used to compare self-reported responses of tooth loss and oral manifestations (i.e., loose teeth, bleeding gums, mouth sores, and dry mouth) among HCPs with and without diabetes.
Almost a quarter of the HCPs reported having diabetes. Among patients with diabetes, more than half were 45–64 years old, had low-income status, and attended rural health centers. Analyses revealed that diabetes was significantly associated with permanent tooth loss and presence of at least one oral manifestation after controlling for confounders. Among adults with diabetes, probability of “missing at least one tooth.” were two times higher compared to not missing any teeth AOR = 2.10, (95%CI 1.40–3.16); P ≤0.001. Adults with diabetes had higher odds of having one or more “oral manifestations” compared to adults without diabetes AOR = 1.60, (95%CI 1.22–2.11); P = 0.001.
Diabetes disproportionately affects HCP adults (23%) compared to the general U.S. adult population (10%). In HCPs having diabetes was associated with a higher prevalence of oral manifestations (i.e., loose teeth, bleeding gums) and losing “At least one” of their permanent teeth. These findings suggest that adults with diabetes had higher prevalence of oral manifestations and tooth loss, highlighting the need for innovative interprofessional models for early screening and identification.
•Diabetes disproportionately affects adults utilizing HRSA funded health centers compared to the general U.S. adult population.•Adults with diabetes experience a higher likelihood of oral complications and subsequent tooth loss.•HCPS data helps policy makers identify opportunities to improve access to primary and preventive health care services.
While a number of studies have explored the link between periodontal disease and adverse pregnancy outcomes, both epidemiological studies and intervention trials have reached contradictory results ...with relatively small sample sizes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes.
Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes.
Using de-identified claims data from a national commercial insurer in the USA, records of all observed pregnancies from 2015 to 2019 were included in this retrospective cohort study. Adverse pregnancy outcomes, including low birthweight (LBW) of the newborn, preterm birth (PTB) and spontaneous abortion, were primary outcomes. To evaluate the association between periodontal disease and pregnancy outcomes, logistic mixed-effect model was estimated with periodontal disease status, age, existing clinical conditions of mothers and geographic location as covariates.
Out of 748 792 observed pregnancy records, 18.66% resulted in adverse pregnancy outcomes; 5.92% in LBW, 14.46% in PTB and 2.22 % in spontaneous abortion. Adjusting for individual-level risk factors, periodontal disease was significantly associated with maternal complications with odds ratios of 1.19 (95% CI:1.15, 1.24) for any adverse pregnancy outcomes, 1.10 (95% CI:1.03, 1.17) for LBW, 1.15 (95% CI:1.10, 1.19) for PTB and 1.34 (95% CI:1.23, 1.46) for spontaneous abortions.
Maternal periodontal disease may be associated with an increased risk of maternal complications and neonatal morbidity. A timely diagnosis and treatment of periodontal disease during pregnancy should be encouraged by considering oral health as part of routine prenatal care.
Objectives
The Coronavirus Disease‐19 (COVID‐19) pandemic highlighted the need for pandemic preparedness (PP) in health professions training. We aimed to (1) establish a current profile on curricular ...content of PP in US dental schools and (2) examine how schools were adapting their curricula in response to COVID‐19.
Methods
An online survey was developed and sent to senior leadership to all 66 Commission on Dental Accreditation (CODA)‐accredited US dental schools including Deans of Academic or Clinical Affairs from November 2020–February 2021. Questions addressed PP curricular content, teaching methods, and evaluation. Participants were asked about the barriers and facilitators for the inclusion of this content. The survey also included questions on redeployment of the clinical workforce in response to the pandemic.
Results
The response rate was 31.8% (n = 21) with representation from every US Census Bureau‐designated division. While all responding dental schools agreed that dental professionals can play an important role during pandemics, 38.1% reported including content on PP into their pre‐ or postdoctoral curriculum. In response to the COVID‐19 pandemic, approximately 47.6% indicated redeployment of their clinical workforce to participate in disaster life support, assisting physicians in COVID‐19 cases, and assisting hospitals with personal protective equipment (PPE).
Conclusion
There was general agreement that dental professionals can play an important role during pandemics. The participating US dental schools responded to the COVID‐19 pandemic by integrating novel clinical activities. More efforts are required to include PP in dental education.
Harvard School of Dental Medicine’ Initiative to Integrate Oral Health and Medicine, in collaboration with Harvard’s Center for Integration Science and Global Health Institute, convened global ...experts in integration science and medical dental integration specifically, to call attention to the need for universal health coverage concepts that incorporate essential oral health services and thereby address equity and population health gaps.Across the globe, there are many innovative financial, clinical and educational programs that strive to provide comprehensive and universal healthcare that includes oral health. The goal of the symposium was to showcase successful examples of programs and policies that are improving health and quality of life, particularly for communities suffering disparities, through the integration of oral healthcare into primary and secondary levels of care.Symposium participants ranged from ministers of health to village healthcare workers to academics, who shared their successes and challenges integrating medical and oral healthcare. However, despite innovative examples spanning integration of care for infectious and noncommunicable diseases as well as social determinants, more work is required to: heighten awareness of the essentialism of oral health; strengthen the evidence for effective oral healthcare; and highlight the opportunity to improve health and equity through interprofessional collaboration.This commentary presents the key points from a subject matter expert discussion, theorizing through the lens of political economy about the challenges to advance the integration of oral healthcare within universal healthcare, and how the inspiring examples of success showcased throughout during the symposium surmounted systemic and cultural barriers to holistic care.
The scientific link between mastication strength and cognitive function has not yet been strongly corroborated in population studies. Utilizing large-scale claims, we aim to investigate the ...association between edentulism and cognitive impairment in older American adults.
Using de-identified claims from a commercial insurer from 2015-2019, we conducted a retrospective cohort study using multilevel regression models to evaluate the association between denture status and clinically diagnosed cognitive impairment. Secondary analysis included symptomatic cognitive impairment in the outcome.
Adjusting for individual-level risk factors, denture status was significantly associated with clinical cognitive impairment with odds ratios of 1.13 (95%CI: 1.02-1.25) and 1.26, (95%CI: 1.09-1.45) for complete dentures on one or both jaws, respectively. Including symptomatic cognitive impairment in the analysis did not substantially change our fundamental findings.
Prevention and treatment of oral diseases should be considered a key component in preserving the overall wellness of older adults.
The Global Health Starter Kit (GHSK) is an interdisciplinary, competency-based, open access global health curriculum covering global disease and demographic trends, Millennium Development Goals ...(MDGs) and Sustainable Development Goals (SDGs), the connection between oral health and overall health, social determinants of health, and concepts of sustainable and ethical global health programs. In this study, we evaluate and describe barriers to and facilitators for using and implementing the GHSK curriculum across a variety of new users.
This two-phase study uses the Roger's Adoption Curve concept to standardize this evaluation and inform a strategic plan for continuing to move the curriculum across the chasm from early adopters to an early majority of global oral health educators and learners. We utilized a theoretical adoption framework to identify facilitators and barriers under the domains of innovation and curricular, educator and learner, and institutional and structural factors. Under qualitative Phase 1, five early adopter institutions were interviewed to elicit understanding of factors that contribute to adoption of the GHSK curriculum. Common themes identified were next used to create a Phase 2 quantitative survey for early majority subscribers of the GHSK (N = 27).
These qualitative and quantitative results showed an overall high satisfaction with the quality of the GHSK materials, but also effectively identified barriers to its adoption, including inexperience of faculty in teaching global oral health, a lack of awareness and marketing, and absence of global health accrediting requirements.
By identifying the barriers and facilitators of GHSK curriculum integration, this study provides concrete and specific opportunities to improve its format, relevance, content, and delivery. This study outlines next steps to creating a standardized approach to successfully adopting competency-based global oral health teaching and learning.
To develop a minimum Adult Oral Health Standard Set (AOHSS) for use in clinical practice, research, advocacy and population health.
An international oral health working group (OHWG) was established, ...of patient advocates, researchers, clinicians and public health experts to develop an AOHSS. PubMed was searched for oral health clinical and patient-reported measures and case-mix variables related to caries and periodontal disease. The selected patient-reported outcome measures focused on general oral health, and oral health-related quality of life tools. A consensus was reached via Delphi with parallel consultation of subject matter content experts. Finally, comments and input were elicited from oral health stakeholders globally, including patients/consumers.
The literature search yielded 1,453 results. After inclusion/exclusion criteria, 959 abstracts generated potential outcomes and case-mix variables. Delphi rounds resulted in a consensus-based selection of 80 individual items capturing 31 outcome and case-mix concepts. Global reviews generated 347 responses from 87 countries, and the patient/consumer validation survey elicited 129 responses. This AOHSS includes 25 items directed towards patients (including demographics, the impact of their oral health on oral function, a record of pain and oral hygiene practices, and financial implications of care) and items for clinicians to complete, including medical history, a record of caries and periodontal disease activity, and types of dental treatment delivered.
In conclusion, utilising a robust methodology, a standardised core set of oral health outcome measures for adults, with a particular emphasis on caries and periodontal disease, was developed.
Purpose/Objectives
Access to dental care for older adults is challenging, especially for those living in rural areas. People living in rural areas are less likely to visit the dentist, have greater ...oral health needs, and face significant oral health disparities. Given the projected increase in the older adult population, the aim of this study was to conduct a scoping review (SR) to identify the current landscape of geriatric dental training in rural healthcare settings.
Methods
Four guiding concepts (i.e., dental workforce, education/training, rural setting, and older adult population) were searched in PubMed, Embase (Elsevier), Dental and Oral Sciences Source (EBSCO), and ERIC (EBSCO) following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. EndNote and Covidence were used for de‐duplication algorithms and title/ screening.
Results
Seventy‐nine citations were identified for the final full‐text review based on inclusion and exclusion criteria, and ten articles were eligible for data extraction as applicable to the research question. Three themes emerged from the review: geriatric dentistry inclusion within dental school curricula, clinical training at rural/remote locations, and improving geriatric oral health knowledge through interprofessional training.
Conclusion
This SR highlights the limited number of currently trained geriatric dentists, as well as, the paucity of dental programs/curricula offered to produce competent dental geriatricians with an advanced skill set for practicing in rural settings. Our review indicates the need to expand the dental workforce, curricula, and training to better position dentists to serve the older and underserved population in rural and remote areas.
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