Baltimore oral epidemiology, disease effects, and HIV evaluation study (BEEHIVE) study protocol: a prospective cohort study.

BACKGROUND: As antiretroviral therapy has become widely available and highly effective, HIV has evolved to a manageable, chronic disease. Despite this health advancement, people living with HIV (PLWH) are at an increased risk for age-related non-communicable diseases (NCDs) compared to HIV-uninfected individuals. Similarly, PLWH are at an increased risk for selected oral diseases. PLWH with a history of injecting drugs experience an even greater burden of disease than their counterparts. The overall objective of the Baltimore Oral Epidemiology, Disease Effects, and HIV Evaluation (BEEHIVE) study is to determine the combined effects of HIV infection and NCDs on oral health status. The specific aims of the study are to: (1) determine to what extent HIV status influences access to and utilization of oral health care services; (2) determine to what extent HIV status affects self-reported and clinical oral health status; (3) determine to what extent HIV status influences the progression of periodontitis; and (4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature. METHODS: The BEEHIVE study uses a prospective cohort study design to collect data from participants at baseline and at a 24-month follow-up visit. Data are collected through questionnaire assessments, clinical examinations, and evaluation of oral microbiological samples to determine the drivers of oral disease among a high-risk population of PLWH with a history of injection drug use and prevalent comorbid NCDs. The established AIDS Linked to the Intravenous Experience (ALIVE) cohort serves as the source of participants for the BEEHIVE Study. DISCUSSION: Upon completion of the BEEHIVE study, the knowledge gained will be important in informing future clinical and preventive interventions that can be implemented into medical and dental practice to ultimately help eliminate long-standing oral health inequities that PLWH experience.

Disparities in Enrollment in Medicare Advantage Plans With Dental Benefits.

This cross-sectional study evaluates the association of Medicare beneficiaries' sociodemographic characteristics with having Medicare Advantage plans that cover oral health services.

An Exploration of Black Men's Attitudes and Experiences Communicating with Dentists about Oral and Pharyngeal Cancer.

BACKGROUND: Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists' limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the attitudes and experiences that Black men have communicating with dentists about OPCs. METHODS: To qualitatively assess these attitudes and experiences, a focus group guide and recruitment strategy were developed using a community engagement approach. Data were analyzed using grounded theory. RESULTS: Twenty-three self-identified Black men participated in three focus groups through the Zoom platform (mean age of 46.1 years). Four main themes emerged, which identified that participants: (1) had little knowledge of OPCs; (2) felt that addressing OPC risk among Black men was not a priority for dentists; (3) stressed the importance of dentists acknowledging the complexity of how race and gender affects Black men's healthcare experiences; and (4) expressed a benefit to receiving information from multiple social networks. CONCLUSION: The focus groups provided context for how dentists might engage with Black men in discussions about OPC prevention and treatment.

Claims analysis of Medicare fee-for-service oral health care encounters, from 2019 through 2021.

BACKGROUND: Many qualifying people rely on Medicare fee-for-service (FFS) for their health care insurance, although it rarely provides coverage for oral health care services. The objective of this study was to gain insights into oral health care that is being provided by all health care provider types for Medicare FFS beneficiaries. METHODS: The authors used the Centers for Medicare & Medicaid Services Virtual Data Research Center to query 100% of Medicare FFS claims from 2019 through 2021 and identify all encounters for which there was either an oral health-related International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code or a CDT 2019-2021: Current Dental Terminology code recorded on the claim. The authors used a cross-sectional study design and calculated descriptive statistics to describe characteristics of identified oral health care encounters. The encounter level was the unit of analysis. RESULTS: A total of 2,098,056 oral health care encounters were identified through Medicare FFS claims during the study observation period, with a lower volume observed after 2019. Nearly 98% of encounters were related to those in which oral health diagnoses were recorded (International Classification of Diseases, Tenth Revision, Clinical Modification code on claim), and non-oral health care providers primarily submitted these claims. Most encounters included beneficiaries with chronic conditions, and a roughly equal proportion included those qualifying for Medicare on the basis of age and disability. CONCLUSIONS: Previously unreported characteristics of oral health care encounters were identified through administrative claims, providing insights into oral health care being provided to a subset of Medicare FFS beneficiaries. PRACTICAL IMPLICATIONS: Future research and policies should focus on strengthening medical-dental integration models and expanding access to oral health care for the Medicare FFS population.

A community-based participatory protocol to improving communication with Black men about oral and pharyngeal cancers: Research protocol.

Black men are disproportionately impacted by oral and pharyngeal cancer (OPC) mortality. This is in part due to a lack of information received about OPCs and their associated risk factors during health encounters. Discussions between dentists and Black men may improve Black men's knowledge, screening, and treatment uptake. Yet, dentists do not commonly communicate with Black men about OPCs due to their own discomfort. This paper describes the protocol for our research project, which proposes an initiative, grounded in community-based participatory research, to adapt a culturally-specific OPC communication tool. This tool will be adapted using a mixed-methods approach to assess the knowledge, attitudes, and experiences of Black men discussing OPCs and associated risk factors with dental providers. The tool will then be assessed for feasibility and acceptability among Black men, as well as dental students and dental providers in community-based clinical settings.

The use of teledentistry in facilitating oral health for older adults: A scoping review.

BACKGROUND: Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services. TYPES OF STUDIES REVIEWED: Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria. RESULTS: Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.

Tooth loss among older adults according to poverty status in the United States from 1999 through 2004 and 2009 through 2014.

BACKGROUND: As tooth loss decreases in an aging United States, retaining enough natural teeth for function is important for quality of life. METHODS: The authors used data from the 1999 through 2004 and the 2009 through 2014 National Health and Nutrition Examination Surveys to assess changes in tooth loss in adults 50 years or older. The authors evaluated changes in edentulism, retaining all teeth, and having a functional dentition (21 or more natural teeth) according to poverty status. RESULTS: Edentulism was lower in 2009 through 2014 than in 1999 through 2004 (11% versus 17%) for adults 50 years or older, but this decrease was not significant among the poor (people at < 100% of the federal poverty guideline; P > .05). Complete tooth retention improved from 14% to 21% between 1999 through 2004 and 2009 through 2014 for people 50 years or older (P < .05). Gains were attributable mostly to adults who were nonpoor (≥ 200% federal poverty guideline). More older adults had a functional dentition in 2009 through 2014 than in 1999 through 2004 (67% versus 55%; P < .05), although the increases generally were significant only for those not living in poverty. CONCLUSIONS: Complete tooth loss has decreased by more than 75% for those aged 65 through 74 years over the past 5 decades in the United States. Improvements in tooth loss measures, such as edentulism and complete tooth retention, have been most significant among the nonpoor, whereas those who are poor have experienced fewer improvements. PRACTICE IMPLICATIONS: An aging population is experiencing less edentulism and greater tooth retention, so older adults may need more regular oral health care and prevention services to address concerns such as root caries and periodontal disease.

The Health System and Policy Implications of Changing Epidemiology for Oral Cavity and Oropharyngeal Cancers in the United States From 1995 to 2016.

Oral cavity and oropharyngeal cancers are typically grouped under the general term, "oral cancer." Yet, the incidence of oropharyngeal cancers is increasing in the United States, while the incidence of oral cavity cancers has declined. These 2 distinct but conflated groups of oral cancers are attributed to different risk factors. Incidence and survival trends were examined across US population groups and by anatomical subsite. Disparities in incidence and survival by sex, race/ethnicity, and subsite were identified. Risk factors are complex, interactive, and not fully identified. Cancer control research illustrates health disparities in access to care and patient outcomes. Database and supplemental searches yielded 433 articles published between 1995 and 2016 characterizing aspects of oral cancer epidemiology relating to incidence, survival, risk, disparities, and cancer control. Oral cavity cancer survival in black men remains the most intractable burden. Although understanding of oral cancer etiology is improving, application to policy is limited. Cancer control efforts are diverse, sporadic, limited in scope, and generally lacking in success, and they need stratification by oral cavity cancers/oropharyngeal cancers. Further intervention and epidemiologic research, improved workforce capacity, and integrated care delivery are identified as important directions for public health policy. Sustained, multilevel campaigns modeled on tobacco control success are suggested.

Racial and Ethnic Differences in Self-Reported Periodontal Disease in the Multi-Ethnic Study of Atherosclerosis (MESA).

PURPOSE: Racial and ethnic disparities in periodontal disease exist in the United States. This study examined the prevalence of self-reported periodontal disease, and the extent to which racial/ethnic disparities in the reported disease were reduced or eliminated after controlling for various risk factors in a multi-ethnic study population of older adults. MATERIALS AND METHODS: Information from the baseline examination (July 2000-August 2002) of the Multi-Ethnic Study of Atherosclerosis (MESA) was used. Study participants (N = 6256) were age 45-84 years and identified themselves as either: white, black, Hispanic or Chinese. Periodontal disease was assessed by self-report; demographic and socioeconomic status (SES) indicators, biomedical risk factors and psychosocial stress factors were used as predictors of self-reported periodontal disease. RESULTS: Chinese displayed the highest prevalence of self-reported periodontal disease (39.8%), followed by blacks (32.0%) and whites (26.0%), with Hispanics displaying the lowest prevalence (17.4%). Chinese and black participants had a significantly higher prevalence of disease compared to whites that persisted after adjusting for demographic and SES indicators, biomedical risk factors and psychosocial stress factors. After such adjustment, Hispanics did not differ significantly from whites in their reporting of disease. CONCLUSION: Racial/ethnic disparities in self-reported periodontal disease persisted after adjusting for all study covariates. This study highlights the need for continued research into the determinants of racial/ethnic disparities in periodontal disease in order to better target interventions aimed at reducing the burden of disease in all segments of the U.S. population.

Maryland Physicians' Knowledge, Opinions, and Practices Related to Dental Caries Etiology and Prevention in Children.

PURPOSE: The purpose of this study was to assess Maryland physicians' knowledge and understanding of dental caries etiology and prevention, opinions related to prevention effectiveness, and their prevention practices. METHODS: In 2010, a 30-item, self-administered survey questionnaire was mailed to a random sample of 1,472 Maryland family physicians and pediatricians, with 294 surveys being returned and usable, yielding a 20 percent return rate. Statistical analyses in this descriptive study included distributions and cross-tabulations for the survey responses. RESULTS: Thirty-five percent of family physicians and 45 percent of pediatricians indicated they provide caries prevention education to their patients. Approximately half of the physicians reported performing some type of caries risk assessment. Out of 10 dental caries knowledge questions, there was not a single question that the majority of physicians answered correctly with certainty. Nine percent of family physicians and 12 percent of pediatricians reported they provided fluoride varnish treatment to their three- to six-year-old patients at the time of this survey. CONCLUSIONS: This study identified specific areas, related to Maryland physicians' dental caries etiology and prevention knowledge, that continuing education and training programs could enhance.

Oral cavity and oropharyngeal cancer incidence trends and disparities in the United States: 2000-2010.

BACKGROUND: Changes in the incidence of oral cancer based on anatomic location and demographic factors over time have been reported in the United States. The purpose of this study was to use recent data to examine oral cancer incidence trends and disparities by demographic factors and anatomic location. METHODS: Surveillance, Epidemiology, and End Results (SEER) incidence data from 2000 to 2010 were used to characterize and analyze oral cancer incidence trends by anatomic region and subsite, age at diagnosis, gender, race/ethnicity, and stage at diagnosis. Poisson regression was used to compare incidence risk by select demographic factors. RESULTS: About 75,468 incident oral cancer cases were diagnosed from 2000 to 2010. The tonsil was the most frequently diagnosed anatomic subsite (23.1%) and the subsite with the greatest contribution to the overall, age-standardized cumulative incidence rate of 8.4 cases per 100,000 (95% confidence interval (CI): 8.3, 8.4). An increasing incidence trend was observed for cancers in the oropharyngeal region, in contrast to a decreasing trend seen in the oral cavity region. In the Poisson regression model, all race/ethnicity groups showed a lower incidence risk relative to whites for oral cavity and oropharyngeal cancer, and white males displayed the highest incidence rate of all race/ethnicity-gender groups during the study period (14.1 per 100,000; 95% CI: 14.0, 14.2). CONCLUSIONS: This study's epidemiological findings are especially important for oral health care providers, patient education, and the identification of risk profiles associated with oral cancer. The distinct epidemiological trends of oral cavity and oropharyngeal cancers dictate that oral cancer can no longer be viewed as a discrete entity. Oral health providers should have a strong understanding of the different risk factors associated with oral cavity and oropharyngeal cancers and educate their patients accordingly.

The use of recommended communication techniques by Maryland family physicians and pediatricians.

BACKGROUND: Health literacy experts and the American Medical Association have developed recommended communication techniques for healthcare providers given that effective communication has been shown to greatly improve health outcomes. The purpose of this study was to determine the number and types of communication techniques routinely used by Maryland physicians. METHODS: In 2010, a 30-item survey was mailed to a random sample of 1,472 Maryland family physicians and pediatricians, with 294 surveys being returned and usable. The survey contained questions about provider and practice characteristics, and 17 items related to communication techniques, including seven basic communication techniques. Physicians' use of recommended communication techniques was analyzed using descriptive statistics, analysis of variance, and ordinary least squares regression. RESULTS: Family physicians routinely used an average of 6.6 of the 17 total techniques and 3.3 of the seven basic techniques, whereas pediatricians routinely used 6.4 and 3.2 techniques, respectively. The use of simple language was the only technique that nearly all physicians routinely utilized (Family physicians, 91%; Pediatricians, 93%). Physicians who had taken a communications course used significantly more techniques than those who had not. Physicians with a low percentage of patients on Medicaid were significantly less likely to use the recommended communication techniques compared to those providers who had high proportion of their patient population on Medicaid. CONCLUSIONS: Overall, the use of recommended communication techniques was low. Additionally, many physicians were unsure of the effectiveness of several of the recommended techniques, which could suggest that physicians are unaware of valuable skills that could enhance their communication. The findings of this study suggest that communications training should be given a higher priority in the medical training process in the United States.