Comparison of initial dental treatment decisions between in-person and asynchronous teledentistry examinations for people with special health care needs.

BACKGROUND: People with special health care needs in long-term care settings have difficulty accessing a traditional dental office. The goal of the authors was to assess initial treatment decision concordance between dentists conducting traditional in-person examinations using mobile equipment and additional dentists conducting examinations using asynchronous teledentistry technology. METHODS: Six dentists from Access Dental Care, a North Carolina mobile dentistry nonprofit, saw new patients on-site at 12 participating facilities or asynchronously off-site with electronic dental records, radiographs, and intraoral images, all captured by an on-site dental hygienist. Off-site dentists were masked to other dentists' treatment need decisions; 3 through 5 off-site examinations were conducted for each on-site examination. Demographic and binary treatment need category data were collected. For the 3 most prevalent treatment types needed (surgery, restorative, and new removable denture), the authors calculated the percentage agreement and κ statistics with bootstrapped CIs (1,000 replicates). RESULTS: The 100 enrolled patients included 47 from nursing homes, 45 from Programs of All-Inclusive Care for the Elderly, and 8 from group homes for those with intellectual and developmental disabilities. Mean (SD) age was 73.9 (16.5) years. Among dentate participants, the percentage agreement and bootstrapped κ (95% CI) were 87% and 0.74 (0.70 to 0.78) for surgery and 78% and 0.54 (0.50 to 0.58) for restorative needs, respectively, and among dentate and edentulous participants, they were 94% and 0.78 (0.74 to 0.83), respectively, for new removable dentures. CONCLUSIONS: The authors assessed the initial dental treatment decision concordance between on-site dentists conducting in-person examinations with a mobile oral health care delivery model and off-site dentists conducting examinations with asynchronous dentistry. Concordance was substantial for surgery and removable denture treatment decisions and moderate for restorative needs. Patient characteristics and facility type were not significant factors in the levels of examiner agreement. PRACTICAL IMPLICATIONS: This evidence supports teledentistry use for patients with special health care needs and could help improve their access to oral health care.

Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned.

The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.

Disseminating oral health educational content and evaluating its use on non-dental safety net clinic websites.

OBJECTIVES: Safety net clinics (SNC) provide healthcare to vulnerable populations and SNC websites are an important information source. In North Carolina (NC), all 100 counties are Dental Health Professional Shortage Areas, yet 91 of 317 SNCs are non-dental (ND-SNC). Our goals were to: (1) assess the presence and type of oral health (OH) information on ND-SNC websites; (2) develop and distribute an OH education webpage to ND-SNCs and track its use. METHODS: The website search function was used with common dental terms to evaluate the presence of OH content on each ND-SNC website. Key representatives from ND-SNCs were surveyed to assess patient care and willingness to implement an OH webpage. Webpage topics included oral hygiene and a map of NC dentists that provide services to low-income patients. Google Analytics was used to track consumer webpage engagement including acquisition source (AS), average time on page (AT), and unique page views (UPV). RESULTS: Of the 91 ND-SNCs websites, none contained OH education; 15% had information about nearby dental providers. For the 40 ND-SNCs using our webpage, January-December 2022, the primary AS for new webpage users was referrals; 72.5% of users visited directly from ND-SNC websites. Statewide AT was 2 min and 30 s (SD = 58 s), 2.88 times longer than the 52-s threshold marketing experts use to establish genuine user engagement. There were 1364 UPVs statewide for 2022. CONCLUSION: Our results suggest a need for OH education content on ND-SNC websites, as users are searching for and engaging with this information.

Ten-year cross-sectional and longitudinal assessment and factors associated with unfavourable self-rated oral health in older adults in the United States.

OBJECTIVE: To investigate the association of demographic and socio-economic characteristics with self-reported oral health (SROH) among older adults who participated in the Health and Retirement Study (HRS) in 2008, 2018, or both, and to describe temporal changes. METHODS: Data were from the University of Michigan's Health and Retirement Study (HRS), a nationally representative longitudinal survey of Americans aged 51 and older. Responses from participants who completed the Core HRS survey and Dental Module (DM) in 2008 (n = 1310), 2018 (n = 1330), and the "common group" at both timepoints (n = 559) were analysed. Using the common group, the outcome measure was 2018 self-rated oral health (Favourable vs Unfavourable). Potential explanatory variables included 2008 self-rated oral health (SROH), sociodemographic, and dental utilisation-related factors. Survey logistic regression analysis was used to identify factors that were associated with unfavourable 2018 SROH in 2018. RESULTS: Unfavourable SROH prevalence was 28.5% and 31.6% in 2008 and 2018, respectively. Among the common, longitudinal group, the unfavourable prevalence remained the same, 26.1% at both timepoints. A positive association was seen between 2018 unfavourable SROH and baseline variables of 2008 unfavourable SROH, male gender, less education, and lower levels of wealth. CONCLUSIONS: Over a quarter of participants reported unfavourable SROH. There was little change in SROH during this period. Sociodemographic factors influence the SROH of the older population. Policies and programs to promote and protect the oral health of older adults should be designed and implemented to reduce social inequalities and improve the SROH of disadvantaged older adults.

Clinician perspectives on implementation of digitally fabricated complete dentures: A national survey of prosthodontists.

STATEMENT OF PROBLEM: Research on implementation factors for digitally fabricated complete dentures is sparse. PURPOSE: The purpose of this survey of prosthodontists was to explore the current usage of conventionally and digitally fabricated complete dentures and to identify factors that may impact their use. MATERIAL AND METHODS: A confidential cross-sectional survey consisting of 20 questions was conducted in 2019 using the Qualtrics Research Suite. The survey was distributed via electronic mail to all 1820 members of the American College of Prosthodontics. Frequency distributions, chi-squared tests, and Fisher exact tests were used to analyze the data and compare subgroups (α=.05). RESULTS: The response rate was 16.8% (N=305). A total of 31.5% of respondents were implementing digitally fabricated complete dentures, 36.6% were interested in learning and/or incorporating them, 37.7% reported that they had not tried them, and 12.7% had tried them but were not interested in using them again. When asked which factors were important when considering the implementation of digitally fabricated complete dentures, 55.8% indicated laboratory costs, 72.1% total chair time spent, and 81.9% patient satisfaction. Prosthodontists who graduated from dental school after about 1991 were more interested in learning about and incorporating digitally fabricated complete dentures than earlier graduates (P=.02). CONCLUSIONS: The survey results indicate that prosthodontists are implementing digitally fabricated complete dentures in clinical practice but not at the rate that might be expected of a technology that has been available for nearly a decade. Factors reported to matter in the decision to implement this technology were decreased time, overall cost, and improved patient satisfaction.

Oral health issues of early baby boomers.

OBJECTIVES: The purpose of this article is to detail the oral health status of early baby boomers and how it is affected by the cultural influences after World War II. METHODS: National data on clinically and self-assessed oral conditions from the 2021 NIDCR Oral Health in America Report, National Health and Nutrition Examination Survey (2011-2014), Center for Disease Control and Prevention, National Cancer Institute (2018), the Indian Health Service (2022), and the Health and Retirement Study (2018) were tabulated and compared (where available) to similar data for older and younger cohorts. RESULTS: Data analyses show that there is more tooth retention overall. There are higher levels of tooth loss, unrestored caries, and periodontitis among Black, American Indian, Alaskan Native, and Hispanic baby boomers, and the poor. Smokers had higher rates of periodontitis. CONCLUSION: A life course approach to oral health care is warranted. Only by regular access and preventive care throughout life can avoidable, unnecessary, overly complex, and invasive procedures be prevented.

Retrospective Study of Prenatal and Postnatal Gaps in Oral Health Care Utilization: Medicaid Policy Implications.

OBJECTIVE: To assess the frequency and timing of dental treatment completion among pregnant and post-partum women served through the University of North Carolina at Chapel Hill (UNC-CH) Prenatal Oral Health Program (pOHP) dental clinic in the context of North Carolina (NC) dental Medicaid policies. METHODS: We completed a retrospective chart review of pregnant women referred to the program between May 2015 and May 2019. Data were collected from the time of referral until up to 2 years after their estimated due date (EDD). We assessed pre- and post-delivery dental appointment timing and dental treatment completion. RESULTS: The initial study population included 264 pregnant women. Overall, 213 patients (81%) attended at least one appointment, and 32 patients (12%) completed recommended treatments prior to their EDD. Fifty patients (19%) returned after delivery to resume dental care, with only 25 patients (10%) completing their recommended treatment plan. Women re-entered dental care at a median of 67 days (range 5-613 days) after their EDD and completed treatment at a median of 378 days (range 52-730 days) following delivery. CONCLUSIONS FOR PRACTICE: Despite dental clinic referral, most pregnant women do not complete recommended dental treatment before giving birth, and women who resumed dental care after birth demonstrated a lag-time between delivery and care completion. These findings highlight the need for extending post-pregnancy dental care coverage, which is limited under current dental Medicaid policies, posing a major public health issue for new mothers to continue oral health care.

Teledentistry: Dental hygiene students' knowledge, attitudes, and curriculum recommendations.

Purpose: Research has shown an increase in dental hygiene (DH) students' knowledge and attitudes toward teledentistry (TD) after TD training in states with permissive but not restrictive DH scope of practice policies. The purpose of this study was to identify self-reported knowledge and attitudes regarding TD among the DH students at the University of North Carolina (UNC) at Chapel Hill before and after an educational intervention and student recommendations for TD curriculum placement.Methods: A faculty presentation and video demonstration, followed by small group discussions and a large group debriefing session were conducted at the UNC Adams School of Dentistry in March 2019. Participants were invited to complete a survey before and after the educational session. McNemar's matched pair test was used to compare the proportion of the participants' pre- and post-test responses.Results: Survey participants (n=30) included first year and second year DH students. There was significant difference (p<0.001) between pre and post self-reported knowledge of TD as well as a significant difference in participant's response (p= 0.012) about facilitating consultation with health care specialists through TD in NC. There was a significant difference in favorable responses (p=0.0394) that TD could increase reimbursement to dentists to enhance the provision of more services in NC. Students identified didactic courses (43%), simulated cases (47%), and integration into the DH community rotations (66%) as potential ways to incorporate TD into curriculum. Most students (93%) identified DH restricted scope of practice as a barrier to TD implementation in NC.Conclusion: The educational session resulted in increased self-reported knowledge and demonstrated positive attitudes toward the adoption of TD into multiple facets of DH curriculum. A major barrier to its adoption into practice is the DH restricted scope of practice in NC.

Family perceptions of mouth care for assisted living residents with dementia: Implications for care.

Mouth care is an important component of care for persons with dementia in assisted living (AL). However, there is little information about family member knowledge, beliefs, and experiences with resident oral health. Family perceptions and involvement in care may impact oral and systemic health for AL residents. Therefore, semi-structured interviews to assess these domains were conducted with 23 adult family members of AL residents with dementia, from 9 AL communities. Thematic analysis found that families identified (1) the centrality of oral health to well-being; (2) organizational influences on mouth care; (3) mouth care in the context of dementia; and (4) collaboration to facilitate mouth care. Family perspectives can provide useful guidance for collaborative interventions that support oral health and mouth care in AL.

Collaborating and teaching a synchronous, multi-university, virtual course: Health policy and access to dental care.

PURPOSE: In response to COVID-19, dental educators have been tasked with maintaining the quality of education while reducing cost, increasing efficiency, and leveraging technology. METHODS: This collaborative, multisite virtual health policy course used the Staged Self-Directed Learning Model (SSDL) to lead a diverse group of students studying health policy. Twelve Core sessions were offered with three additional sessions in August or December for a total of 15 total synchronous Zoom sessions that covered policy issues on supply, demand, and need for dental care. RESULTS: Twenty-eight students, seven lead instructors, and two course directors from six schools reported positive feedback on the course format, use of technology and the SSDL model, and breadth of topics presented. Participation by universities in four states with differing health policies stimulated virtual classroom discussions. CONCLUSION: In conclusion, collaborative interinstitutional virtual teaching and learning is cost effective, efficient, and engaging for students. This model has the potential to continue even when institutions are no longer affected by COVID-19.

Assessing oral health content in nondental professional association websites.

OBJECTIVES: Determine the prevalence and type of oral health (OH) content among nondental health professional associations' websites. METHODS: Fifty-nine organizations were selected from three lists of health professional associations and categorized as physician-, nurse- and other healthcare-related professions. Eight dental search terms were used on searchable websites. Six types of OH information were collected. Websites were assessed for any OH content and comparisons made. Frequencies, chi-square, and Fisher extract test statistics were calculated. RESULTS: Thirty-five (59 percent) of websites had any OH information content. Twenty (34 percent) had OH authored content, 10-19 percent had OH webpages, interest groups, or initiatives, CE courses or webinars, or curriculum information. The term "oral hygiene" gave the greatest yield and "dentistry" the least. No significant differences in existence of "Any OH content" was found between each organization type versus others. CONCLUSION: Many nondental professional associations could increase OH website content and education with assistance from dental organizations.

Risk Indicators of Urgent and Extensive Dental Treatment Needs in U.S. Air Force Recruits.

INTRODUCTION: Dental Readiness Classifications (DRCs) enable the Military Health System to prioritize dental care in garrison, minimizing dental emergencies and mission degradation during deployments. Over half (52.4%) of 2008 military recruits presented with high-priority urgent needs classified as DRC3 upon initial dental examination and 18.1% required extensive treatment, needing 7 or more restorations, in order to achieve operational dental readiness. The purpose of this study is to identify risk indicators for urgent and extensive dental treatment needs in current U.S. Air Force (USAF) recruits so that Dental Corps leadership can target interventions to maximize oral health, prioritize resources, and reduce health expenditures in this patient population. MATERIALS AND METHODS: A secondary data analysis was performed of deidentified survey and clinical exam data from the 2018 to 2019 USAF Recruit Oral Health Surveillance study conducted at Lackland Air Force Base from February 2018 to February 2019. Select demographic and self-reported variables were analyzed with two outcome variables: urgent (DRC3) and urgent and extensive (DRC3 + 7) dental treatment needs. Univariate log binomial regression was performed to determine relative risk of DRC3 and DRC3 + 7 by independent variable. The Uniformed Services University of the Health Sciences institutional review board approved the study as an exempt protocol. RESULTS: Among the 1,335 recruits studied, the overall prevalence of urgent dental needs was 21.5%, whereas 5.5% of participants had both urgent and extensive needs. The study group included participants who were mostly male (69%), were non-Hispanic white (60%), aged 17 to 19 years (48%), were high school educated (47%), had private dental insurance coverage (50%) and self-reported: no need for dental care in the past year (65%), excellent or good condition of teeth (63%), were toothbrushing more than once a day (58%), and had daily consumption of one to three servings of sugary beverages (62%) and foods (69%). Statistically significant differences in relative risk for DRC3 were found for all independent variables except gender and education level. Risk indicators significant for DRC3 and DRC3 + 7 were aged 25 to 29 years; Other and Black race/ethnicity; Medicaid insurance; uninsured; self-reported fair, poor, or unsure current condition of teeth; and past year needed care but did not go (P < .05). The majority of DRC3 and DRC3 + 7 cases were in the small subset of recruits who self-reported fair, poor, or unknown current condition of teeth or need for dental care in the past year without a dental visit. CONCLUSIONS: Among USAF recruits, oral health disparities are observed in certain groups. The study findings can inform targeted utilization of resources and interventions to efficiently optimize oral health and operational dental readiness and decrease dental expenditures. Additionally, a two-question screening tool is proposed to facilitate priority assignment for dental examination during boot camp. This tool has the potential to correctly identify nearly 90% of those with urgent and extensive dental treatment needs at half the typical workload.

Responding to a pandemic: Development of the Carolina Dentistry Virtual Oral Health Care Helpline.

BACKGROUND: A virtual oral health care help line was established to provide consultation and triage for people with dental questions and concerns. Its goal during a pandemic was to keep patients from seeking unnecessary in-person care from emergency departments and urgent care clinics, especially when dental practices were closed or limited to providing essential urgent and emergency oral health care. METHODS: The Adams School of Dentistry, University of North Carolina at Chapel Hill, developed the Carolina Dentistry Virtual Oral Health Care Helpline using a quality improvement framework with faculty and staff member feedback. The process included establishing infrastructure (phone, video, protocols, referrals, documentation), personnel (scheduling, training, calibration), and internal and external communication. The authors collected retrospective information for descriptive evaluation of the first month's operations. RESULTS: There were 337 telephone calls answered, of which 65 (19%) were administrative and 272 (81%) were related to dental concerns. Dental pain (54%) was the most prevalent reason for calling. Triage and Providers referred 107 of 175 callers (61%) to the school's urgent care center. Of the 79 callers who received teleconsultations from virtual providers, 33 (42%) did not require additional follow-up, and 7 (9%) needed a follow-up phone call. Overall, 4 people were referred to community clinics, and 4 were referred to the emergency department. CONCLUSIONS: The Helpline was launched quickly and improved through quality improvement cycles, and it provided a needed community dental service. The process resolved some patient concerns without their seeking urgent or emergency care. PRACTICAL IMPLICATIONS: The pandemic has increased teledentistry practice. The authors describe establishing a dental school's virtual oral health Helpline, which provides a framework for dental practices seeking to use this patient communication modality.

Oral Health and COVID-19: Increasing the Need for Prevention and Access.

Populations disproportionately affected by coronavirus disease 2019 (COVID-19) are also at higher risk for oral diseases and experience oral health and oral health care disparities at higher rates. COVID-19 has led to closure and reduced hours of dental practices except for emergency and urgent services, limiting routine care and prevention. Dental care includes aerosol-generating procedures that can increase viral transmission. The pandemic offers an opportunity for the dental profession to shift more toward nonaerosolizing, prevention-centric approaches to care and away from surgical interventions. Regulatory barrier changes to oral health care access during the pandemic could have a favorable impact if sustained into the future.

Teledentistry Knowledge and Attitudes: Perspectives on the role of dental hygienists.

Purpose. The first statewide teledentistry (TD) Summit in North Carolina (NC) was convened by the University of North Carolina (UNC) at Chapel Hill in 2018. The purpose of this analysis is to compare Summit participants' understanding of TD, its benefits, challenges, solutions and the role of dental hygienists, pre- and post-Summit.Methods. Summit invitees included leaders in related policy, education, advocacy, legislation, technology and UNC dental hygiene and dental students. Descriptive analyses and exact McNemar's matched pair tests compared proportions of participants' responses to pre- and post-Summit surveys.Results. Response rates were pre-Summit 75.3% (n= 58) and post-Summit 70.1% (n= 47); matched pre-post survey pairs (n=42). Pre-Summit respondents reported their primary role in administration (48.0%), teaching and mentoring (21.0%), patient care (12.0%) or as a student (19.0%). Among respondents, overall self-reported TD knowledge increased from 38.1% to 92.9%, p< 0.001. Their reported extent TD should be developed in NC increased from 78.6% to 95.2%, p = 0.07; the extent hygienists should have a role in TD services increased from 83.3% to 88.1%, p = 0.73. The most frequently mentioned challenge was state practice acts requiring direct supervision of dental hygienists, limiting their TD use in community settings, which increased in the pre- to post-surveys from 33.3% to 59.5% respectively, p = 0.01.Conclusion. Among attendees at the statewide TD Summit, self-reported knowledge was high and attitudes favorable for moving forward with TD in NC. However, state dental practice act barriers restricting dental hygienist participation in TD was the first challenge respondents thought needed to be addressed.

The Evolving Role of Health Literacy in Improving Oral Health.

This chapter provides a review of the evolution of oral health literacy including its impact on oral health outcomes, the current status of oral health literacy initiatives and future research needs. Using the Healthy People 2010 definition, the chapter describes opportunities needed to improve oral health literacy among health providers as well as individuals/patients, communities and policy-makers. Studies of the two most prevalent dental diseasesâATdental caries and periodontal diseases - reveal that increasing the oral health literacy of the public and health care providers can play a major role in reducing these diseases. Increasing oral health literacy by creating access to accurate knowledge and supporting use of science-based preventive measures is essential. A major part of the chapter describes oral health literacy's influence in the integration of dental and medical care. The chapter provides an extensive list of research needed to further our understanding of the impact of oral health literacy on health disparities and the health of the population.

Audiology and oral health professional students: An interprofessional education collaboration.

OBJECTIVES: Audiology knowledge is important for oral health professionals because patients may present with hearing loss or temporomandibular joint dysfunction with referred pain to the ear. Additionally, their occupational environment may negatively affect their own hearing. An interprofessional learning experience for dental (DDS), dental hygiene (DH), and audiology students was created to increase DDS and DH students' knowledge of the audiology profession, risks to their own hearing, and communication with hearing-impaired patients. This study's purpose was to evaluate this new educational experience. METHODS: In 2018, audiology students presented information to DH and DDS students about audiology and offered optional supervised hearing screenings. DDS and DH students were surveyed to assess their self-rated knowledge level on audiology topics (e.g., audiology profession, hearing assessment, noise-induced hearing loss, and communicating with hearing impaired patients) before and after the educational sessions, as well as to evaluate their learning experience. Audiology students received didactic and hands-on instruction by DDS and DH students and faculty on performing a head and neck exam and making appropriate referrals. RESULTS: The response rate was 48% (n = 57). Students' reported knowledge on all topics significantly improved (P < 0.05) after the educational program. The majority, 86%, agreed that this experience should be added to the curriculum, and 92% reported it increased their understanding of the importance of collaborating with other health professionals. CONCLUSIONS: This experience increased students' knowledge of the audiology profession and understanding of hearing loss, while also increasing their appreciation of interprofessional education.

Trends and determinants of drinking water practices among North Carolina children.

OBJECTIVES: To identify trends and determinants of drinking water practices [bottled (BW) versus community water (CW) consumption] among families of pediatric patients presenting to an academic dental institution over 15 years. METHODS: Electronic health record data were obtained for all first-time routine-care patients ages 0-16 presenting to UNC-Chapel Hill's Pediatric Dentistry Clinics from 2002 to 2016, including families' primary drinking water source and patient demographics (e.g., age, gender, residence, insurance status). Data analyses included descriptive and bivariate methods and multivariable modeling using a P < 0.05 statistical significance criterion. RESULTS: BW consumption has increased over time, from 17 percent in 2004 to 42 percent in 2016 (n = 2,920; P < 0.05). Medicaid-enrolled children [prevalence ratio (PR) = 2.1; 95% confidence interval (CI) = 1.8-2.4] and residents of rural counties (PR = 1.3, 95% CI = 1.1-1.5) were significantly more likely to consume BW versus CW. CONCLUSIONS: BW consumption among NC children has been increasing and is most prevalent among low-income families and in rural areas.