Integration of dental therapists in safety net practice increases access to oral health care in Minnesota.

OBJECTIVES: This study evaluates the impact of introducing dental therapists (DTs) into Children's Dental Services (CDS), a large non-profit organization in Minnesota. The aim is to assess the effect of DTs in improving access and reducing dental care costs in Minnesota by analyzing the trends in dental care delivery and procedures performed by CDS dentists and therapists. METHODS: Using 2009 to 2021 data from CDS, the study compares trends in patient volume, types of procedures, salary data and payments by dentists, DTs, and registered dental hygienists (RDH). Return on investment (ROI) trends are calculated using salary and revenues for each provider type. RESULTS: After introducing DTs at CDS and implementing mobile clinics, the number of patients served and volume increased steadily, demonstrating increased access. DTs provided an increasing proportion of fluorides, sealants, and extractions through 2020. Interestingly 2021, there was a decrease for DTs, possibly due to Covid related workforce shortages. ROI analysis showed that DTs' ROI dramatically rose, eventually surpassing dentists, while RDHs maintained a constant ROI. Dentists' ROI also initially increased after adopting DTs in the practice. CONCLUSION: Integrating DTs at CDS improved access by expanding mobile clinics, increasing patient volume, and redistributing procedures, while demonstrating a positive return on investment. Results suggest that adopting the DT model may be a promising practice for other organizations seeking to improve access to dental care, increase operational efficiency, and boost the dental care team's ROI.

Dental Therapists' Impact on Access to Care and Oral Health Equity.

Dental therapists (DTs) have been treating patients in the United States since 2004, and the evidence is unequivocal. DTs provide safe, high-quality, cost-effective care to thousands of patients.1-3 Presently, 12 states have authorized DTs, and an additional eight states are pursuing legislation to bring these professionals to the oral healthcare team.4,5.

Outcomes from the Health Resources and Services Administration's Dental Faculty Development Program.

PURPOSE/OBJECTIVES: While the Commission on Dental Accreditation (CODA) requires programs to conduct faculty development, implementation of faculty development activities vary widely. Faculty development programs can enhance teaching, research, and leadership skills needed to transition from clinical practice to teaching. In 2012, the Health Resources and Services Administration (HRSA) funded 6 institutions to plan, develop, and operate programs for training oral healthcare providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene. This performance study examines the results of the dental faculty development programs. METHODS: After the 5-year grant program (2012-2017), we used descriptive analysis to examine annual performance data including trainee demographics, faculty development activities, post-completion intentions, and course development activities. RESULTS: Nearly 300 trainees participated across 6 funded grantees; the majority were female, aged 30-49 years, and non-Hispanic White. For those who completed, 80% intended to teach. Common faculty development activities included community-based training, curriculum enhancements, Web-based training, and interprofessional education methods. Faculty development modalities included faculty seminars, Master's degrees, and mentoring. Pipeline activities, online resources, and continuing education supported dental students and providers moving into academics. CONCLUSIONS: Faculty development better prepares individuals to compete in academic environments and develop faculty. Community-based programs may utilize faculty development to recruit community preceptors and achieve calibration. HRSA investment in faculty development programs builds resources and infrastructure to promote continuing engagement in clinical education, research, and administrative skills. Future research is needed to establish the impact of faculty development initiatives on practice change and patient outcomes.

In Defense of Dental Therapy: An Evidence-Based Workforce Approach to Improving Access to Care.

This article addresses new systems and practice models in community-based dentistry. Its purpose is twofold: to identify strategies and policies that support health equity and access to care; and to identify promising efforts that serve as new models for change in the dental workforce. Dental therapy meets both of these purposes and is the major focus of this article. The fundamental premises explored are threefold. First, the dental care system in the U.S. is broken for many people who then suffer the consequences of poor oral health; this is especially true for racial and ethnic minorities and lower income populations. Second, dental therapy is a proven, safe, high-quality, cost-effective, and ethical way to improve access to oral health care and oral health in general. Third, opposition to dental therapy comes only from the leadership of organized dentistry and is without an evidence base to support objections and criticism. This article reviews each of these three premises in detail. Based on this review, the article concludes that dental therapy is a safe, high-quality, effective, and ethical approach to improve the oral health workforce, increase access to dental care, and achieve oral health equity.

Are dental providers the next line of HPV-related prevention? Providers' perceived role and needs.

The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance "primordial prevention," or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists' perceived roles and needs regarding HPV-related primordial prevention. We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests. Participants affirmed dental professionals' roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention. Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers' professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers' needs for following professional organizations' guidance to advance prevention efforts and reduce HPV-related cancer incidence.

Assessing dentists' human papillomavirus-related health literacy for oropharyngeal cancer prevention.

BACKGROUND: Oropharyngeal cancers related to human papillomavirus (HPV) are on the rise. Dentists may be the next group of providers participating in the prevention of HPV. The aim of this study was to assess dentists' health literacy regarding the connection of HPV and oropharyngeal cancer. METHODS: The authors conducted 4 focus groups with dentists (N = 33) during a regional dental conference in 2016. Guided by the health literacy competencies (that is, access, understand, appraise, and apply), the authors used constant comparison methods for data analysis. RESULTS: Dentists mentioned a variety of informational sources (for example, dental journals and colleagues). Knowledge about the link between HPV and oropharyngeal cancer varied among participants. Participants appraised multiple patient and practice factors when deciding to have the discussion with patients. Some dentists discussed the HPV and oropharyngeal cancer connection with patients, and most conducted secondary screenings. CONCLUSIONS: Findings indicate areas for intervention, including creating awareness of trusted informational sources, as well as increasing HPV knowledge and understanding the multiple patient (for example, age) and practice (for example, open operatories) appraisal factors. Moreover, enhancing the communication skills of dentists with patients is needed to improve HPV-related cancer prevention education. PRACTICAL IMPLICATIONS: Addressing dentists' HPV-related health literacy has the potential to improve dentists' HPV-related prevention practices, including expanding patient education about this topic and increasing HPV vaccination knowledge, ultimately contributing to the reduction of oropharyngeal cancers.

Health Literacy Approaches to Improving Communication between Dental Hygienists and Patients for HPV-Related Oral Cancer Prevention.

Purpose: Human Papillomavirus (HPV) has been identified as a causal agent for oropharyngeal cancers, suggesting a new role for dental hygienists in HPV-related cancer prevention strategies. Health literacy assessment is an approach that can be used to understand providers' informational assets and needs for educating and discussing HPV prevention with patients. This study aimed to understand dental hygienists' level of health literacy regarding HPV-related oropharyngeal cancers.Methods: Four focus group sessions with dental hygienists (n=48) were conducted at a national conference. The constant comparison method, with a priori codes for health literacy competencies (i.e., access/understand/appraise/apply), was utilized for this qualitative study.Results: Participants mentioned a variety of modes (e.g., magazines, journals) for accessing HPV-information; however, descriptions of understanding HPV and its relationship to oropharyngeal cancer varied. Participants considered patients' personal characteristics, the dental practice environment, and professional factors to appraise HPV-related information. Additionally, participants self-described themselves as being "prevention specialists." These factors influenced how dental hygienists applied primary and secondary prevention of HPV-related care issues with their patients (e.g., education and oral-cancer screenings).Conclusions: Dental hygienists recognized the importance of HPV and oropharyngeal cancer prevention efforts, including oral-cancer screenings and promotion of the HPV vaccine. The study findings identified opportunities for intervention focusing on primary prevention.

Emerging Models of Dental Practice Aim at Addressing Needs of the Aged.

Currently, about 46 million seniors, citizens over the age of 65, live in the United States. That number is expected to roughly double to more than 98 million by 2060, an increase from the current 15% of the population to 24%. Seniors are living longer and, due to advances in dental care and access to fluoridated water, keeping more of their teeth. As a result, many will be seeking to access services through a dental care delivery system that is already struggling to meet existing need. This article will describe emerging oral health workforce models, as well as interprofessional team approaches, that may help improve access to the growing population of senior citizens. The article will include discussions on dental therapists, dental hygienists, physicians, nurses, and physician assistants.

Expected Changes in Regulation and Licensure: Influence on Future Education of Dentists.

This article is based on the following assumptions about dental care in the United States: there is an access to oral health care problem; the number of individuals with dental insurance is increasing; the demographics of the dental profession does not mirror the overall demographics of the U.S. population; and emerging oral health workforce models may help improve access to care. Based on these assumptions, this article explores related licensure and regulatory factors that will influence the education and practice of dentists in the future. The issues discussed are licensure of emerging oral health practitioners, mobility of the dental health care workforce, corporate ownership of dental practices, ethical issues related to use of human subjects in dental licensure examinations, interprofessional education and practice, and health care reform. The licensure and regulatory bodies discussed are the Commission on Dental Accreditation (CODA), state legislatures and boards of dentistry, federal legislative activities, judicial activities, and the Federal Trade Commission. Recommendations based on this discussion are presented. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Addressing Oral Health Disparities Via Educational Foci on Cultural Competence.

An ever-present challenge for the oral health profession is to reduce the extent of oral disease among racial and ethnic minority populations. Adding to this complex dilemma is the linkage between oral health and systemic health. We describe enhanced cultural competency, in the context of individual cultural beliefs, values, language, practice, and health behaviors, among dental professionals, as one approach to meeting the dental care needs of the underserved. An overview and examples of teaching methods used by University of Florida dental educators to enhance student cultural competency is provided. Evidence-based evaluation results provide evidence of methodology efficacy. We conclude by describing actions that can be implemented by academic dental institutions to facilitate development of culturally competent practitioners.

Measuring quality: caries-related emergency department visits and follow-up among children.

OBJECTIVE: This study validated two Dental Quality Alliance system-level measures of oral healthcare quality for children - caries-related emergency department (ED) visits and timely follow-up of those visits with a dentist - including formal validation of diagnosis codes used to identify caries-related ED visits and measurement of follow-up care. METHODS: The measures were specified for implementation with administrative claims data and validated using data from the Florida and Texas Medicaid and Children's Health Insurance Programs. Measure specification testing and measure score validation used administrative data for 7,007,765 children. We validated the diagnosis codes in claims data by comparisons with manual reviews of 300 records from a Florida hospital ED and calculation of the kappa statistic, sensitivity, and specificity. RESULTS: Overall agreement in caries-related ED visit classifications between the claims data and record reviews was 87.7 percent with kappa = 0.71, sensitivity = 82 percent, and specificity = 90 percent. The calculated measure scores using administrative data found more than four-fold variation between programs with the lowest and highest caries-related ED visit rates (6.90/100,000 member months and 30.68/100,000 member months). The percentage of follow-up visits within 7 days and 30 days ranged from 22-39 percent and 34-49 percent, respectively. CONCLUSIONS: These National Quality Forum endorsed measures provide valid methodologies for assessing the rate of caries-related ED visits, an important system-level outcome indicator of outpatient prevention and disease management, and the timeliness of follow-up with a dentist. There is significant variation in caries-related ED visits among state Medicaid programs, and most ED visits do not have follow-up with a dentist within 30 days.

Using a stakeholder-engaged approach to develop and validate electronic clinical quality measures.

OBJECTIVE: To describe the stakeholder-engaged processes used to develop, specify, and validate 2 oral health care electronic clinical quality measures. MATERIALS AND METHODS: A broad range of stakeholders were engaged from conception through testing to develop measures and test feasibility, reliability, and validity following National Quality Forum guidance. We assessed data element feasibility through semistructured interviews with key stakeholders using a National Quality Forum-recommended scorecard. We created test datasets of synthetic patients to test measure implementation feasibility and reliability within and across electronic health record (EHR) systems. We validated implementation with automated reporting of EHR clinical data against manual record reviews, using the kappa statistic. RESULTS: A stakeholder workgroup was formed and guided all development and testing processes. All critical data elements passed feasibility testing. Four test datasets, representing 577 synthetic patients, were developed and implemented within EHR vendors' software, demonstrating measure implementation feasibility. Measure reliability and validity were established through implementation at clinical practice sites, with kappa statistic values in the "almost perfect" agreement range of 0.80-0.99 for all but 1 measure component, which demonstrated "substantial" agreement. The 2 validated measures were published in the United States Health Information Knowledgebase. CONCLUSION: The stakeholder-engaged processes used in this study facilitated a successful measure development and testing cycle. Engaging stakeholders early and throughout development and testing promotes early identification of and attention to potential threats to feasibility, reliability, and validity, thereby averting significant resource investments that are unlikely to be fruitful.

The Impact of an Infant Oral Health Program on Dental Students' Knowledge and Attitudes.

The high prevalence of early childhood caries and many general dentists' reluctance to treat young children and pregnant women demand new educational programs to foster delivery of oral health services. The aim of this study was to evaluate the impact of an Infant Oral Health Program (IOHP) at the University of Florida College of Dentistry on dental students' knowledge about and willingness to provide dental care for infants, children up to three years of age, and pregnant women. A total of 233 dental students in the first through fourth years and recent graduates completed a survey that assessed the educational outcomes of the IOHP; only the fourth-year students had received IOHP training. The results showed that females were more likely than males to provide counseling to caregivers about dental and physical development (p=0.024) and to offer restorative treatment to young children (p=0.021). Older students were more likely than younger students to provide restorative treatment (p=0.013). A greater percentage of IOHP-trained students (96%) reported knowing how to use the lap examination technique compared with untrained students (71%; p<0.001). IOHP-trained students were the most uncomfortable dealing with a crying child in the dental chair (p=0.0175). The graduates and fourth-year students were significantly more likely than the other cohorts to provide preventive (p=0.001) and restorative (p<0.001) care for pregnant women. The graduates were least likely to use some form of caries risk assessment (p<0.001). These findings highlight the need for earlier and greater exposure to the IOHP and the importance of promoting awareness about risk assessment and oral disease management.

Delayed tooth emergence in children infected with human immunodeficiency virus.

OBJECTIVE: There is limited evidence that early deficits in growth might be reflected in tooth emergence in children infected with human immunodeficiency virus (HIV). The purpose of this study was to prospectively evaluate tooth emergence timing between children positive and negative for HIV in the exposed and unexposed groups, respectively. STUDY DESIGN: A longitudinal study of children positive for HIV and HIV-negative household peers, aged 2 to 15 years was conducted between 1993 and 1996. Emergence status was determined for the maxillary and the mandibular permanent first molars and the central and lateral incisors. A multivariable, discrete time, proportional hazards model was fitted to the data. Median age of emergence for each of the six pairs of teeth was calculated using the parameter estimates from the regression model. RESULTS: A total of 116 participants (62 HIV positive, 54 HIV negative) completed six examinations over the 36-month study period. Statistical differences in tooth emergence timing were observed for five of the six tooth pairs, with children positive for HIV being less likely to have emergence of the corresponding tooth compared with the children negative for HIV. Age differences for each tooth pair ranged from 0.7 to 1.5 years, with a median emergence age difference of 1.03 years. CONCLUSIONS: Delayed tooth emergence of the permanent dentition was observed in children with HIV.

Assessing Cultural Competence among Florida's Allied Dental Faculty.

PURPOSE: The Commission on Dental Accreditation requires that dental, dental hygiene and dental assisting schools offer educational experiences to ensure that prospective dental health care providers become culturally competent, socially responsible practitioners. To assert that these mandates are met requires that the faculty are knowledgeable and capable of providing this type of training. Currently, little is known about the cultural competence of the state of Florida allied dental faculty. The purpose of this study was to assess the cultural competence among the dental hygiene and dental assistant faculty in the state of Florida. METHODS: One hundred ninety-three faculty were invited to take the Knowledge, Efficacy and Practices Instrument (KEPI), a validated measure of cultural competence. Respondents included 77 (74%) full-time and 27 (26%) part-time faculty. Data were analyzed descriptively and reliabilities (Cronbach's alpha) were computed. RESULTS: Mean scores and internal estimates of reliability on the KEPI subscales were: knowledge of diversity 3.3 (ɑ=0.88), culture-centered practice 3.6 (ɑ=0.88) and efficacy of assessment 2.9 (ɑ=0.74). The participant's score of 3.6 on the culture-centered practice exceeds scores among dental students and faculty who participated in previous studies suggesting the allied dental faculty have a greater awareness of sociocultural and linguistically diverse dental patients' oral health needs. Participants' score on knowledge of diversity subscales suggests a need for moderate training, while their score on the efficacy of assessment subscale indicates a need for more intense training. CONCLUSION: Assessing faculty beliefs, knowledge and skills about cultural competency is critically important in ensuring that accreditation standards are being met and represents one step in the process of ensuring that faculty demonstrate the type of sensitivity and responsiveness, which characterizes behaviors associated with cultural competence.

Trends in dental-related use of hospital emergency departments in Florida.

OBJECTIVES: The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care. METHODS: Data for this study were drawn from ambulatory ED discharge records compiled by Florida's Agency for Health Care Administration for 2005-2014. Visits for dental-related reasons in Florida were defined by the patient's reported reason for seeking care or the ED physician's primary diagnosis using ICD-9-CM codes. We calculated frequencies, age-specific and age-adjusted rates per 100,000 population, and secular trends in dental-related ED visits and their associated charges. RESULTS: The number of dental-related visits to Florida EDs increased each year, from 104,642 in 2005 to 163,900 in 2014; the age-adjusted rate increased by 43.6 percent. Total charges for dental-related ED visits in Florida increased more than threefold during this time period, from $47.7 million in 2005 to $193.4 million in 2014 (adjusted for inflation). The primary payers for dental-related ED visits in 2014 were Medicaid (38 percent), self-pay (38 percent), commercial insurance (11 percent), Medicare (8 percent), and other (5 percent). CONCLUSIONS: Dental-related visits to hospital EDs in Florida have increased substantially during the past decade, as have their associated charges. Most patients did not receive definitive oral health care in EDs, and this trend represents an increasingly inefficient use of health care system resources.

Assessing Faculty Development Needs among Florida's Allied Dental Faculty.

PURPOSE: Professional schools rarely prepare prospective academic faculty for the responsibilities of college and university teaching. Without this training, faculty are often left to discover on their own and to varying degrees of success what is expected of them once they enter the academy. At the same time, universities and colleges recognize that retention of faculty depends on the successful transition of academics into the related roles and responsibilities of the professoriate. The purpose of this study was to assess the faculty development needs among allied dental faculty, specifically the state of Florida's dental hygiene and dental assisting faculty, by measuring the following: the relationship between their knowledge and priorities for further training, their level of satisfaction with current faculty development opportunities and mentoring, and their perceptions of what additional training and resources might advance their careers. METHODS: Two hundred and four full-time and part-time faculty were invited to participate in this survey research study. McNemar's test for paired binary data was used to analyze the level of agreement between knowledge and indicated priority. Responses to open ended questions were coded and categorized thematically. RESULTS: There were 115 responses (n=204, 74%). There were statistically significant differences between participants' ratings of knowledge and priorities for further training on many items related to teaching, scholarship and leadership skills. Participants also identified 5 categories of unmet needs. CONCLUSION: The findings suggest that universities and colleges need to offer learning experiences aimed at strengthening the teaching, scholarship and leadership skill needs of their allied dental faculty. Additionally, professional schools might consider offering a program track that provides prospective allied dental faculty with the types of opportunities that develops teaching, scholarship and mentoring skills prior to graduation.