Teledentistry utilization by oral health professionals and policy considerations: A mixed methods case study.

OBJECTIVES: To examine variations in the delivery of teledentistry after the COVID-19 pandemic and to explore oral health professionals' utilization of various teledentistry modes of delivery. METHODS: In this mixed methods case study, we collected teledentistry claims data from patient electronic health records (n = 78,756) encompassing various types of teledentistry utilization in clinical settings and through community outreach from a Dental Support Organization (DSO) in Oregon from January 2021 to November 2022. We analyzed the patient demographic and claims data using descriptive statistics and logistic regression analyses to identify patterns of teledentistry service delivery. Qualitatively, we conducted virtual interviews (n = 13) through Microsoft Teams with oral health professionals about their experiences with teledentistry utilization. We used inductive and deductive coding to code individual transcripts and identify common themes among provider experiences. RESULTS: Out of the 78,756 electronic health record claims for teledentistry, 75.7% used synchronous audio, 13.4% used synchronous video, and 10.9% used asynchronous teledentistry methods. We observed a 8.6% increase in synchronous audio teledentistry utilization at the end of the study period, compared with a 4.2% increase in synchronous video and a 4.4% decrease in asynchronous teledentistry. Oral health professionals interviewed reported choosing the type of teledentistry delivery based on patient and provider access to the virtual teledentistry platform. CONCLUSION: Oral health professionals' knowledge of and experiences with teledentistry need to be considered when developing policy and best practices for the use of teledentistry for patient care.

Community Awareness and Oral Cancer Screening in Rural Wisconsin.

Purpose: Oral cancer risks have been shown to be modified by improving public awareness and reducing barriers to preventive care. The purpose for this study was to assess oral cancer knowledge and awareness and provide oral cancer screenings and education to a population of rural farmers in Wisconsin.Methods: Attendees 18 years of age and older at a rural farming exposition in Wisconsin were invited to complete a 12-item oral cancer awareness paper survey and to receive a visual and tactile head and neck examination/ oral cancer screening. Completing both the survey and the screening were optional. Participants also received educational materials on oral cancer. Individuals with abnormal lesions were provided with dental referrals.Results: A total of 236 attendees consented to participate either the survey or oral cancer screening (n=236). Most (72%) reported seeing a dentist in the past six months regardless of insurance status. In spite of having had recent dental encounters, only 28% of women and 46% of men were able to identify at least one risk factor associated with oral cancer. Among participants consenting to the oral cancer screening (n=194), 17% (n=33) presented with oral lesions requiring additional assessment and were recommended for follow-up care.Conclusions: Knowledge and awareness of oral cancer risk factors, signs and symptoms was low among the participants in this rural population despite high rates of dental care access. Oral cancer screenings and education provided in varied settings could improve oral cancer knowledge and awareness and early detection of malignant oral lesions in rural communities.

Parent-perceived challenges related to the pediatric cochlear implantation process and support services received in South Africa.

OBJECTIVE: To determine and describe parent-perceived challenges related to the pediatric cochlear implantation process and support services received. METHOD: A multicenter survey study across six cochlear implant (CI) programs in South Africa (SA) was conducted. The study sample included 82 parents of pediatric (≤18 years) CI recipients with at least 12 months CI experience. A self-administered questionnaire was developed for the purpose of this study, exploring parental challenges regarding the CI process, education of their implanted children and the support services received. RESULTS: The financial implications of cochlear implantation, including CI device maintenance, were identified by parents as the most prominent challenge. Financing issues were the highest scoring reason that attributed to the delay between diagnosis of hearing loss and cochlear implantation, as well as the greatest barrier to bilateral implantation. Parent-perceived educational challenges included finding adequate educational settings specific to the individual needs of their child and a shortage of trained teachers equipped to support children with CIs. The presence of one/more additional developmental conditions and grade repetition were associated with more pronounced parent-perceived educational challenges. Parents considered speech-language therapy as the most critical support service for their implanted children to achieve optimal outcomes, while parent guidance was indicated to be the most critical support service required for parents of pediatric CI recipients. CONCLUSION: A greater understanding of parent-perceived challenges will guide CI professionals to promote optimal outcomes, evidence-based service delivery and on-going support to pediatric CI recipients and their families. Study results imply a call for action regarding financial and educational support for pediatric CI recipients in SA.

Recognizing Poor Sleep Quality Factors During Oral Health Evaluations.

Oral health practitioners routinely perform oral health assessments for the dental patient to determine if oral disease is present. Systemic health is often a contributor to oral health concerns. One area in particular that has a direct effect on oral structures and oral health is poor sleep quality and open mouth breathing. Sleep is a fundamental process of the human body, which regulates core biological functions. Sleep quality reflects a person's ability to fall asleep, stay asleep, and enter into the various rejuvenating sleep cycles for the full duration. A person who does not obtain quality sleep can exhibit a wide range of oral, systemic, and cognitive health problems. Obstructive sleep apnea, which historically has been considered an adult male disease, is being recognized more often in women children. Research suggests various oral malformations found in newborns and young children can manifest as obstructive sleep apnea in adults. Oral health professionals are in a position to recognize the relationship between sleep and health, identify sleep quality concerns in relation to oral health assessments, administer sleep quality assessments, and determine appropriate referrals for further sleep quality evaluation.

The Oral Health Needs of Wisconsin Farmers and the Need for Patient Activation: A Pilot Study.

OBJECTIVES: This study aimed to determine the level of oral health need of Wisconsin farmers based on sociodemographic variables, perceived oral health, and actual oral health, and to evaluate the effectiveness of a dental hygiene patient activation intervention. METHODS: Oral health screenings were administered by calibrated dental hygienists to 60 Wisconsin farmers attending the 2016 Wisconsin Farm Technology Days. Study participants self-administered the Oral Health Inventory Profile-14 survey and participated in an Adult Basic Screening Survey. Validity and reliability of both instruments have been established in previous studies. A follow-up phone call for Wisconsin farmers with a moderate- to high-risk oral health condition determined study participants followed the dental hygiene recommendations signified if study participants followed the dental hygiene recommendations and if patient activation had been achieved. RESULTS: Study participants represented Wisconsin farmers (N = 60; n = 32 men, n = 28 women) with an average age range between 50 and 60 years old. The Oral Health Impact Profile-14 survey results indicated that this group of Wisconsin farmers did not perceive themselves to have an oral health problem. The Adult Basic Screening Survey results also indicated that the majority of study participants did not currently have active oral disease. There were 32% (n = 19) who qualified for follow-up phone call, with 15% (n = 3) seeking oral health care based on the dental hygiene recommendation. Significant associations between sociodemographic variables and actual oral health were not found, and the null hypotheses were not rejected. CONCLUSIONS: Findings suggest that this group of Wisconsin farmers is receiving regular oral health care and patient activation despite literature suggesting that farmers and rural individuals might face unique barriers to health and oral health care.

Anger on the internet: the perceived value of rant-sites.

Despite evidence that anger is routinely expressed over the Internet via weblogs, social networking Web sites, and other venues, no published research has explored the way in which anger is experienced and expressed online. Consequently, we know very little about how anger is experienced in such settings. Two studies were conducted to explore how people experience and express their anger on a particular type of Web site, known as a rant-site. Study 1 surveyed rant-site visitors to better understand the perceived value of the Web sites and found that while they become relaxed immediately after posting, they also experience more anger than most and express their anger in maladaptive ways. Study 2 explored the emotional impact of reading and writing rants and found that for most participants, reading and writing rants were associated with negative shifts in mood.

Intensive care services in the Veterans Health Administration.

OBJECTIVE: We describe the national organization and distribution of intensive care services within the Veterans Health Administration (VHA), the largest single integrated health-care system in the United States. DATA SOURCES: Data come primarily from the 2004 Survey of Intensive Care Units in VHA, an electronically distributed survey of all ICUs in the VHA. Medical directors and nurse managers from all 213 ICUs in the VHA responded to the survey. In addition, we extracted data on the number of ICU admissions and unique veterans served from national VHA databases. RESULTS: The VHA has a geographically dispersed, multilevel system of care with variation in geographic access for eligible veterans (varying from 3.1 to 3.5 ICU beds per 1,000 patient discharges) and variation in service provision (from 10 to 19 level 1 ICUs across four regions). Level 1 ICUs are the highest tertiary-level ICUs, with the full range of subspecialty care. The proportion of beds associated with VHA-developed ICU levels of care ranges from 55% level 1 beds in the Northeast to 73% in the South, while level 4 beds represent 4% of all ICU beds in the South and 10% in the Midwest. CONCLUSIONS: Overall, the VHA system has a fair amount of regional variation, but level 1 ICUs are available in all geographic regions, and there are regional clusters of all levels. Adopting a four-level system for rating ICUs may assist in monitoring and assessing the quality of care provided in the smallest, most rural facilities.