A Cross-Sectional Analysis of Community Water Fluoridation and Prevalence of Pediatric Dental Surgery Among Medicaid Enrollees.

Importance: Dental surgery under general anesthesia (DGA) is an ineffective, costly treatment for caries. Interventions to reduce the need for DGA are challenging because children's parents may not seek care until surgery is required. Community water fluoridation (CWF) effectively prevents early childhood caries, but its effectiveness in reducing severe early childhood caries is unknown. Objective: To determine whether access to CWF is associated with the prevalence of DGA. Design, Setting, and Participants: This is a cross-sectional analysis of Medicaid claims data from 2011 to 2012. Deidentified data were derived from Medicaid claims and enrollee files for Massachusetts, Texas, Connecticut, Illinois, and Florida for children aged 9 years and younger enrolled in either a fee-for-service or managed care plan through their state's Medicaid program. Linear regression models tested for associations between CWF and covariates. Multivariable linear regression models tested for associations between CWF and outcomes. Regression models included clustered SEs at the county level. Data analysis was performed from December 2018 to March 2020. Exposures: Access to CWF was determined by estimating the proportion of a county's total population that had access to a fluoridated public water system. Main Outcomes and Measures: The main outcome was county-level DGA prevalence. Other outcomes were caries-related visit prevalence and patient quality indicators (asthma and diabetes). Covariates included county-level demographic, socioeconomic, and dental practitioner variables. Results: A total of 436 counties within 5 states per year (872 county-year observations), were included in the analysis. Adjusted analysis revealed that a 10% increase in the proportion of county's population access to CWF was associated with lower caries-related visit prevalence (-0.45 percentage points; 95% CI, -0.59 to -0.31 percentage points; P < .001). Increasing CWF access in 10% increments was associated with decreased DGA prevalence in unadjusted analysis (-0.39 percentage points; 95% CI, -0.67 to -0.12 percentage points; P = .006) but not in adjusted analysis (-0.23 percentage points; 95% CI, -0.49 to 0.02 percentage points; P = .07). Increasing the proportion of county's access to CWF by 10% was not associated with the prevalence of asthma-related exacerbations (-0.02 percentage points; 95% CI, -0.10 to 0.05 percentage points; P = .53) or diabetes-related exacerbations (-0.0003 percentage points; 95% CI, -0.0014 to 0.0009 percentage points; P = .66). Conclusions and Relevance: This study extends our understanding of CWF's benefits for children's oral health. Specifically, these findings suggest that increasing a population's access to CWF's is associated with decreased caries-related visits and may also be associated with use of dental surgical services within high-risk populations.

Anxiety and dental treatments in a hospital in Lima, Peru / Ansiedad y tratamientos dentales en un hospital de Lima, Perú

Background: The dental treatment anxiety affects patient care consultation, regardless of the dental specialty, each with own treatment acts. Objective: To determine the anxiety level of dental treatment of operative dentistry and oral surgery in a hospital of Lima. Methods: The study was conducted in the specialties of operative dentistry and oral surgery, with 72 patients from each specialty, chosen at random over a period of five months, through their answers at Beck Anxiety Inventory. Results: The level of anxiety of patients was similar in the two specialties (p = 0.402). No statistical significant difference was found between anxiety and the patient's sex (p = 0.06), nor with the age of the patient (p = 0.08), nor with the sex of the operator (p = 0.521). The higher frequency of anxiety was the minimum level, 86.1% in operative dentistry and 79.2% in oral surgery. A difference was found between anxiety levels of patients from each specialty (p < 0.001). Conclusions: The frequency of anxiety before entering the specialty was similar, minimum level. Other research is required to determine whether the degree of anxiety is related to the patient's care to dental specialties services.

Introducción: la ansiedad ante un tratamiento odontológico repercute en la asistencia de los pacientes a consulta, independientemente de la especialidad odontológica, cada una con actos propios de tratamiento. Objetivo: determinar el nivel de ansiedad ante el tratamiento de operatoria dental y de cirugía bucal en un hospital de Lima, Perú. Métodos: el estudio fue realizado en las especialidades de operatoria dental y cirugía bucal, con 72 pacientes de cada especialidad, elegidos de manera aleatoria durante un periodo de cinco meses, quienes respondieron el Inventario de Ansiedad de Beck. Resultados: el nivel de ansiedad de los pacientes fue similar en las dos especialidades (p = 0.402). No hubo diferencias entre ansiedad y sexo del paciente (p = 0.06), entre ansiedad y la edad del paciente (p = 0.08), y tampoco con el sexo del operador (p = 0.521). El nivel de ansiedad predominante en todos los pacientes, fue mínimo, 86.1% en operatoria dental y 79.2% en cirugía bucal. Al comparar por separado los niveles de ansiedad de los pacientes de cada especialidad, hubo diferencias en cada caso (p < 0.001). Conclusiones: el nivel de ansiedad antes de entrar a la especialidad de operatoria dental y cirugía bucal fue similar, mínimo. Se deben realizar otras investigaciones para establecer si el grado de ansiedad se relaciona con la asistencia del paciente a los servicios de especialidades odontológicas.

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics.

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time (N = 57) to participate in an internet-based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3-5-year-old patients (ß = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off-site satellite dental clinics (ß = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (ß = .091, p < .0001) and glass ionomer (ß = 103, p < .0001) more frequently and were less likely to use amalgam (ß = -.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

[Professional liability claims against dentists]. / Responsabilidad sanitaria en odontólogos: Casuística de casos evaluados en el Servicio Médico Legal de Chile.

BACKGROUND: The frequency and features of malpractice lawsuits against dentists in Chile are not well known. AIM: To determine the magnitude and frequency of professional liability claims against dentists. MATERIAL AND METHODS: A retrospective analysis of the Medical Liability Unit of the Legal Medical Service of Chile database. This public organization deals with most professional liability claims in Chile. RESULTS: Between 2007 and 2012, 3,990 expert opinions about liability of health care professionals were requested. Odontology was the fifth specialty most commonly sued and dentists, the second most frequently sued professionals. Sixty nine percent of cases originated in private clinics, which is coincident with a higher frequency of dentists working in private practice. Most petitioners were adult women and most claims originated from surgical interventions and infections. In 35% of claims against dentists, a violation of Lex Artis was confirmed, compared with 9% of all expert opinions that generated in the unit. CONCLUSIONS: Claims against dentists are more common than previously thought and these professionals should adopt preventive measures to avoid them.

A new dental insurance scheme--effects on the treatment provided and costs.

The aim of this study was to investigate whether the revenues cover the costs in a pilot capitation plan, a dental insurance scheme, and to compare this capitation plan (CP) with the original fee-for-service system (FFS), in terms of the amount and type of dental care provided. Data was collected longitudinally over a period of three years from 1,650 CP patients in five risk groups at a test clinic, and from 1,609 (from the test clinic) and 3,434 (from a matched control clinic) FFS patients, in Göteborg, Sweden. The care investigated was the number of total treatments provided and the number of examinations by dentists and dental hygienists, together with preventive, restorative and emergency treatments. The economic outcome was positive from the administrator's perspective, in all risk groups for the three-year period. The amount and type of care provided differed between the payment models, as CP patients received more preventive treatments, less restorative treatments, and more examinations by dental hygienists than the FFS patients. Emergency treatment was performed more often on CP patients, and the difference was due to a higher frequency of such treatments among women in the CP group. The difference between clinics concerning certain treatment measures was sometimes greater than the difference between payment models. The results from this study indicate a net positive economic outcome for the pilot CP system over three years. The payment model and the clinic affiliation had impact on what type and amount of dental care the patients received. This might suggest that the risk of skewed selection and its consequences as well as the influence of clinic-specific practice need further investigation, to ensure economic sustainability in a longer perspective.

Dental school vacant budgeted faculty positions, academic years 2008-09 to 2010-11.

The annual turnover of dental school faculty creates a varying number of vacant budgeted positions from year to year. The American Dental Education Association (ADEA) conducts an annual survey to determine the status and characteristics of these vacant faculty positions. The number of vacant budgeted faculty positions in U.S. dental schools increased throughout the 1990s, with a peak of 417 positions in 2005-06. Since that time, there has been a decrease in the number of estimated vacancies, falling to 227 in 2010-11. The 2008-09 to 2010-11 faculty vacancy surveys explored these decreases, along with information relevant to the number and characteristics of dental faculty vacancies, including data on the distribution of full-time, part-time, and volunteer faculty, reasons for faculty separations, and sources of new faculty.

Access to dental services for head and neck cancer patients.

Dental assessment is important for patients with cancer of the head and neck who are to have radiotherapy, as many of these patients have poor dental health before they start treatment. This, compounded by the fact that radiotherapy to the head and neck has a detrimental effect on oral health, has led the National Institute for Clinical Excellence (NICE) to issue guidance that the dental health of these patients should be assessed before treatment. Unfortunately some multidisciplinary teams, such as the one at United Lincolnshire Hospitals, do not have access to a restorative dentist or a dental hygienist. In a retrospective survey we investigated access to general dental services by patients with head and neck cancer who were to have radiotherapy at our hospital and found that 37/71 (52%) had not been reviewed by a dentist within the past 12 months. A secondary national survey that investigated the availability of restorative dental and dental hygienic services showed that of the 56 multidisciplinary teams that deal with head and neck cancer in England, 19 (34%) do not have access to a restorative dentist and 23 (41%) do not have access to a dental hygienist, suggesting that this problem may be countrywide.

Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey.

BACKGROUND: Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. METHODS: A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. RESULTS: Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. CONCLUSIONS: It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.

The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study.

BACKGROUND: Dental care is the most common unmet health care need for children with chronic conditions. However, anecdotal evidence suggests that not all children with chronic conditions encounter difficulties accessing dental care. The goals of this study are to evaluate dental care use for Medicaid-enrolled children with chronic conditions and to identify the subgroups of children with chronic conditions that are the least likely to use dental care services. METHODS: This study focused on children with chronic conditions ages 3-14 enrolled in the Iowa Medicaid Program in 2005 and 2006. The independent variables were whether a child had each of the following 10 body system-based chronic conditions (no/yes): hematologic; cardiovascular; craniofacial; diabetes; endocrine; digestive; ear/nose/throat; respiratory; catastrophic neurological; or musculoskeletal. The primary outcome measure was use of any dental care in 2006. Secondary outcomes, also measured in 2006, were use of diagnostic dental care, preventive dental care, routine restorative dental care, and complex restorative dental care. We used Poisson regression models to estimate the relative risk (RR) associated with each of the five outcome measures across the 10 chronic conditions. RESULTS: Across the 10 chronic condition subgroups, unadjusted dental utilization rates ranged from 44.3% (children with catastrophic neurological conditions) to 60.2% (children with musculoskeletal conditions). After adjusting for model covariates, children with catastrophic neurological conditions were significantly less likely to use most types of dental care (RR: 0.48 to 0.73). When there were differences, children with endocrine or craniofacial conditions were less likely to use dental care whereas children with hematologic or digestive conditions were more likely to use dental care. Children with respiratory, musculoskeletal, or ear/nose/throat conditions were more likely to use most types of dental care compared to other children with chronic conditions but without these specific conditions (RR: 1.03 to 1.13; 1.0 to 1.08; 1.02 to 1.12; respectively). There was no difference in use across all types of dental care for children with diabetes or cardiovascular conditions compared to other children with chronic conditions who did not have these particular conditions. CONCLUSIONS: Dental utilization is not homogeneous across chronic condition subgroups. Nearly 42% of children in our study did not use any dental care in 2006. These findings support the development of multilevel clinical interventions that target subgroups of Medicaid-enrolled children with chronic conditions that are most likely to have problems accessing dental care.

[Health insurance reimbursement of dental care in Hungary]. / A fogászati ellátás egészségbiztositási finanszírozása Magyarországon.

The aim of this study was to assess the annual health insurance reimbursement of dental health service in Hungary. The assessment base of the study was the annual reports of National Health Insurance Fund Administration (OEP). Only the data collected from the services in contractual relationship with the OEP and delivered in 2008 were evaluated. Dental care services are organised in different levels: general dental service, specialist dental care, special dental care on university level and inpatient departments. Our study covers primary, outpatient and hospital dental care. Dental care was supplied by 3.378 general and specialist dental care services at the end of 2008. For the hospital treatment of more serious cases 17 inpatient departments are available with 154 patient beds. Within the period of examination (2008) 23.6 million interventions were carried out in 7.6 million cases. The total health insurance reimbursement of dental care (including primary, outpatient and hospital care) was 24.92 billion HUF (88.82 million Euro) in 2008. The health insurance reimbursement of dental care in Hungary is approximately 2% of the total health insurance expenditures of the National Health Insurance Fund Administration (OEP). Within the period under investigation, the health insurance reimbursement of dental care did not change significantly.

A community-based randomized trial of postcard mailings to increase dental utilization among low-income children.

PURPOSE: Increasing awareness about the importance of preventive dental care among low-income families has been considered to be key to overcoming nonfinancial access to care barriers for children. The purpose of this randomized, controlled trial was to measure the impact of postcard mailings on dental utilization by low-income children through a dental society program designed to increase access to dental care. METHODS: Five thousand eight hundred and seven low-income 2- to 4-year-olds were randomly assigned to 1 of 3 groups: (1) Group 1 (n=2,014) received postcards containing information on how to enroll in the Yakima County Access to Baby and Child Dentistry program; (2) Group 2 (n=2,014) received the enrollment information as well as additional information on the availability of fluoride varnish and the need to visit the dentist by the age of 1-year-old; and (3) Group 3 (n=1,779) did not receive postcards. RESULTS: Preventive services utilization rates were not different among the groups: 61% for Group 1, 62% for Group 2, and 60% for Group 3, although rates were high for a Medicaid population. CONCLUSIONS: Postcard mailings did not significantly increase utilization of preventive dental services. Other strategies to increase utilization of preventive oral health measures are needed.

A national survey of oral and maxillofacial surgeons' attitudes towards the treatment and dental rehabilitation of oral cancer patients.

AIMS: To investigate the attitudes of maxillofacial surgeons in the treatment and dental rehabilitation of oral cancer patients in the UK. MATERIAL AND METHODS: The survey was conducted by postal questionnaires with 17 close-ended questions. A total of 229 questionnaires were sent to members of the British Association of Oral and Maxillofacial Surgeons over a one week period. A follow-up was sent if a reply was not received within 12 weeks. These results were compared to a similar study that was carried out approximately 15 years ago. RESULTS: The response rate was 65.5% (150/229). Overall 62% of respondents (92/150) carried out maxillary resections, which represents a decline of 23% on the previous study. There has been an increase in surgeons reconstructing the maxillary defect from 38% in the 1995 study to 91% in the present study. Ninety-eight percent of respondents had their patients seen in a multidisciplinary team (MDT) clinic, but in only 30% of the cases was a restorative dentist present on these clinics. There has been an improvement in the accessibility of a restorative dentist for this patient cohort, from 65% to 90%. The use of implants for dental rehabilitation post-cancer surgery has increased from 43% to 93%. CONCLUSION: This study highlights the changes in the dental and oral rehabilitation of patients undergoing resective surgery for oral cancer and especially those undergoing a maxillectomy procedure. It illustrates the increased use of implants for post-surgery rehabilitation and shows the different trends in which these implants are placed. An important aspect of this study is the input of the dental team. Current national guidelines state that a consultant restorative dentist needs to be a member of the MDT; this survey shows that this was the case in only 30% of responses.

Day surgery visits for dental problems.

OBJECTIVES: To fill an information gap for dental care policy stakeholders in Canada, this pilot study explored the nature of day surgery (DS) visits for dental problems in Ontario, the country's largest province. METHODS: The Canadian Institute for Health Information's National Ambulatory Care Reporting System was used, which contains demographic, diagnostic, procedural and administrative information for ambulatory care settings across Ontario. Fiscal years 2003/2004 to 2005/2006 data were included for DS visits that had a main problem coded with an International Classification of Diseases code in the range K00-K14, representing diseases of the oral cavity, salivary glands and jaws. RESULTS: During this period, approximately 75 791 persons made 79 133 DS visits for dental problems in Ontario. Proportionally, children under 5 years of age with dental caries represent the majority of DS visits. Restorations and extractions were the most frequently performed DS care procedure. CONCLUSIONS: This is the first study of its kind in Canada, and confirms many of the assumptions held about DS care for dental problems. The study also acts as a baseline for ongoing quality improvement and planning within the province of Ontario.

Do dental educators need to improve their approach to teaching rubber dam use?

Most dentists are educated in rubber dam use in dental school, but there is often disparity between what is taught for various restorative procedures and what is practiced in the private sector. It is a common, although undocumented, belief that few practicing dentists routinely use rubber dam isolation. This study repeated a survey conducted in 1985 evaluating U.S. general dentists' attitudes toward rubber dam usage to see if improvement is needed in current dental educators' approach to this topic. Four hundred dentists were selected randomly from ten major geographically diverse cities using the website YellowPages.com. Each was mailed a letter requesting survey participation, which included a pre-stamped, pre-addressed postcard with the survey printed on the back. The target population, general dentists, returned 164 surveys (41 percent). Their responses can be summarized as follows: 71 percent do amalgams-of those, 53 percent never use a rubber dam whereas 12 percent always use a rubber dam; 100 percent do anterior direct resin composites-of those, 45 percent never use a rubber dam whereas 17 percent always use a rubber dam; 98 percent do posterior direct resin composites-of those, 39 percent never use a rubber dam and 18 percent always use a rubber dam; and 78 percent do endodontic procedures-of those, 11 percent never use a rubber dam whereas 58 percent always use a rubber dam. Most (74 percent) felt that their dental school rubber dam training was adequate; 42 percent felt that its use has an effect on the quality of restorative dentistry. Their most common reasons for not using a dam were the following: inconvenience (40 percent); unnecessary (28 percent); other (12 percent); patient refusal (11 percent); and time (9 percent). No respondent indicated that "cost" was a reason for not using rubber dams. This study indicates that many general dentists in this country continue to ignore the rubber dam for many restorative and some endodontic procedures. It indicates that predoctoral dental educators need to look for opportunities for improvement to reduce the discrepancy between what is taught and the general practice of dentistry.

Development and testing of revised practice belief scales among private general dental practitioners.

BACKGROUND: Practice beliefs have been related to service rate variation and appropriateness of care. The aim of this paper was to further develop practice belief scales by adding new items to an existing set and testing associations with dentist and practice characteristics, and services provided. METHODS: Practice belief items were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 2004 (response rate = 76.8 per cent). RESULTS: Factor analysis yielded five factor-based scales, with three having adequate or near adequate internal consistency: Professional Autonomy (alpha = 0.72), Patient Focus (alpha = 0.71) and Preventive Orientation (alpha = 0.59). Responses were skewed towards strongly agree (scores 1-<2) for Professional Autonomy (60.6 per cent), Patient Focus (71.7 per cent) and Preventive Orientation (46.3 per cent). Higher percentages of dentists with strong agreement on Patient Focus were aged 30-39 and 60+ years, while lower percentages of dentists with strong agreement on Preventive Orientation were male (Chi-square, P < 0.05). Those strongly agreeing with the scales (scores 1-<2) had (Poisson regression; P < 0.05): lower rates of restorative, a rate ratio (RR) of 0.93, dentures (RR = 0.72) and extractions (RR = 0.63) for Professional Autonomy; higher rates of dentures (RR = 1.32), crowns (RR = 1.46) and extractions (RR = 1.47) for Patient Focus; and lower rates of restorative (RR = 0.88), dentures (RR = 0.78), crowns (RR = 0.72), extractions (RR = 0.50), endodontics (RR = 0.80), but a higher rate of scaling (RR = 1.13) for Preventive Orientation. CONCLUSIONS: The findings confirmed some of an earlier factor structure of practice beliefs, extended the potential practice belief domains, and demonstrated associations with service rates.

A survey of consultants and specialists in restorative dentistry on their use of health-related quality of life questionnaires.

A national survey of 178 consultants and specialists in restorative dentistry was undertaken to assess their use of health-related quality of life questionnaires in patients having oral rehabilitation following treatment for oral cancer. The response rate was 74% (132). 42% treated patients following oral cancer, 25% forming part of the head and neck multidisciplinary team. Only 19% had ever used questionnaires. Main barriers to their use were lack of experience with evaluation (27%), lack of staff to administer questionnaires (21%) and insufficient time (18%). Few clinicians thought that questionnaires were not clinically relevant or that no suitable instrument existed. In order to facilitate the use of an oral rehabilitation-specific questionnaire in clinical practice there needs to be greater awareness of the potential benefits, training in the process and the means of reducing the administrative burden.

Prospective evaluation of the referral pattern to restorative dentistry consultation clinics in Ireland.

The objective of this study was to analyse pattern of referral to Restorative Dentistry Consultation Clinics in a Dental Teaching Hospital. Patient demographic details and referral information were collected on new patient clinics. The majority of patients were female (62.1%). The greatest proportion of patients, 41.6%, was referred from the adjacent urban area. The highest percentage of referrals was from general practitioners, (37.6%). The main referral reasons were periodontal (24.7%), fixed prosthodontics (18.6%), endodontics (10.7%) and removable prosthodontics (8.3%). The study clearly showed that the majority of patients referred were female and from close proximity to the Hospital. Patients were referred for a broad range of restorative reasons.

Scope of practice comparison: a tool for curriculum decision making.

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (<0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.