Texas First Dental Home: A Snapshot after Five Years.

BACKGROUND: Early caries is still the most prevalent disease of childhood. Its incidence continues to be high, despite recent progress in the amount of untreated caries. The disease is more prevalent in low socio-economic and minority groups. To address this issue, in 2008 Texas implemented the First Dental Home Program for Medicaid children from 6 to 35 months old. The program consists in providing up to 10 preventive and oral health education visits to children very early in life. A specific dental visit code and a bundled payment of $94 were offered to insure adequate dental provider participation. Little is known about the program results to date. This paper evaluates program development at 5 years. METHODS: Two data sets on first dental home patients and providers were obtained from the Texas Department of Health Services. The data cover a 5-year period (3rd quarter of 2008 to end of 2nd quarter 2013). Program participants were geocoded and their distribution was compared to dental underserved areas. Program uptake over time and the relationship between provider and patient locations were also evaluated. RESULTS: The program covered 440,191 children between September 1st, 2011 and February 28th, 2013. All but two counties in Texas had at least one patient enrolled in the program. As expected, program uptake was higher in highly populated and economically disadvantaged counties. Forty-five percent of Texas licensed dentists participated in the program. The number of dental providers certified to provide first dental home services was highly correlated with the number of patients enrolled in the program (r = 0.893). The number of children participating in the program was between 20.4% and 23%. 29.7% of the first dental home patients had only one visit while only 17.1% had five or more visits. The number of patients and the number of visits per patient peaked at the end of 2011 and flatten thereafter. CONCLUSION: Many children benefited from the program since its rollout. However, despite considerable financial resources and dental provider participation, the uptake of the first dental home program by Medicaid beneficiaries could be improved. Moreover, those who participate do not always take full advantage of the program. Without adequate participation, the desired outcomes of the program may not materialize. Additional efforts to catalyze program development and on-going evaluation may be needed.

Demographic characteristics of orthodontic practice sites in the United States.

Few studies have addressed the demographic characteristics of dental-practice sites, including orthodontic practice sites. In this study, we investigated the demographic characteristics of orthodontic practice sites in the United States. Demographic data and orthodontic practices were organized by zip codes and analyzed with discriminant analysis. The demographic characteristics associated with zip codes that contained an orthodontic practice were determined vs those without an orthodontic practice. The resulting model correctly classified 90.3% of the 30,134 zip code areas, based on the presence or absence of an orthodontic practice. The variables most closely associated with a zip code containing an orthodontic practice included number of dental practices (general practice) and population size. Several variables related to the socioeconomic status of the area were also positively related to zip codes with an orthodontic practice. Further analysis indicated a positive relationship between the model's output and its ability to predict single vs several orthodontic practices in a zip code area. A practical method for assessing the relative merits of alternate site locations is also provided.

Relationship Between Dental Hygiene Students' Performance in an Oral Radiology Course and the National Board Dental Hygiene Examination: A Retrospective Study.

Dental hygiene students' performance in oral radiology courses may give an early indication of their readiness prior to taking the National Board Dental Hygiene Examination (NBDHE). The aim of this study was to determine the relationship between dental hygiene students' performance in an oral radiology lecture course and their performance on the NBDHE. Data were collected for all 117 dental hygiene students at Texas A&M University College of Dentistry from 2006 to 2009 who took the NBDHE during their second year of the program. Their final grades and scores on three written section examinations in an oral radiology course taken in their first year were compared with their overall NBDHE scores and raw scores on the oral radiology and case study sections. Moderate correlations (0.3

Analysis of the demographic characteristics of pediatric dental practice sites.

PURPOSE: The purposes of this study were to: (1) investigate the demographic characteristics of pediatric dental practice sites in the United States; and (2) develop a model that identifies practice site characteristics commonly associated with pediatric dental practices. METHODS: Demographic data and pediatric dental practices were organized by zip codes and analyzed using discriminant analysis. The demographic characteristics associated with zip codes that contained a pediatric dental practice were determined. RESULTS: The resulting model correctly classified 92% of the 30,134 zip code areas, based upon the presence or absence of a pediatric dental practice. The variables most closely associated with a zip code containing a pediatric dental practice included: (1) number of dental practices (general practice); (2) percent of the adult population with a college degree; and (3) population size. CONCLUSIONS: Demographic characteristics are predictive of sites with or without a pediatric dental practice. Zip codes with large, urban populations that have positive socioeconomic characteristics, such as high income and education levels, are the most likely to have a pediatric dental practice. There are a significant number of zip codes in the United States (1,712) that have the demographic characteristics associated with a pediatric dental practice site but do not have a pediatric dentist in them.

Demographic characteristics of general dental practice sites.

This study investigates the demographic characteristics of general dental practice sites in the United States and develops a model that identifies practice site characteristics commonly associated with general dental practices. Demographic data and general dental practices were organized by zip codes and analyzed using Discriminant Analysis. The demographic characteristics associated with zip codes that contained a general dental practice were determined. The resulting model correctly classified 85.2% of the 30,115 zip code areas, based on the presence or absence of a general dental practice. The variables most closely associated with a zip code containing a general dental practice included population size, age distribution of the population, educational background, and economic status. Demographic characteristics are predictive of sites with or without a general dental practice. Zip codes with large, urban populations that have positive socio-economic characteristics, such as high income and education levels, are the most likely to have a general dental practice. A significant number of zip codes in the U.S. (852) have the demographic characteristics associated with a general dental practice site but do not have a general dentist.

Demographic characteristics of endodontic practice sites in the United States.

Few studies have addressed the demographic characteristics of dental practice sites including endodontic practice sites. This study investigated the demographic characteristics of endodontic practice sites in the United States. Demographic data and endodontic practices were organized by zip codes and analyzed using discriminant analysis. The demographic characteristics associated with zip codes that contained an endodontic practice were determined versus the characteristics of zip codes that did not contain an endodontic practice. The resulting model correctly classified 93.7% of the 30,171 zip code areas based upon the presence or absence of an endodontic practice. The variables most closely associated with a zip code containing an endodontic practice included: number of dental practices (nonendodontic), population size, percent of adult population with a college degree, size of employed population, projected population growth (2005 to 2010), percent of population over 64 years old, and median housing value.

Comparative evaluation of endodontic irrigants against Enterococcus faecalis biofilms.

The aim of this study was to compare the efficacy of root canal irrigants against E. faecalis biofilms using a novel in vitro testing system. Biofilms grown in a flow cell system were submerged in test irrigants for either 1 or 5 minutes. Statistical analysis revealed a significant relationship between test agent and percentage kill of the biofilm bacteria (P < 0.05). No statistically significant relationship between time and percentage kill was found. The percentage kill of the biofilm bacteria was: 6% NaOCl (>99.99%), 1% NaOCl (99.78%), Smear Clear (78.06%), 2% chlorhexidine (60.49%), REDTA (26.99%), and BioPure MTAD (16.08%). Post-hoc analysis showed a significant difference between 1% and 6% NaOCl, and all other agents including Smear Clear, 2% chlorhexidine, REDTA, and BioPure MTAD (P < 0.05). Within the parameters of this study, both 1% NaOCl and 6% NaOCl were more efficient in eliminating E. faecalis biofilm than the other solutions tested.

Grading dental students in a "nongraded" clinical assessment program.

This article details how Baylor College of Dentistry (BCD) merges graded and nongraded aspects of student assessments into grade point averages (GPAs); explains the use of its assessment tools to evaluate students, faculty, and curriculum simultaneously; and calls for continuous progress and quality improvement toward educational excellence among all levels of the oral health education community. "Nongraded" student assessments at BCD are only applicable to preclinical and chairside activities that involve direct patient care. We further summarize how we have attempted to improve the accuracy of grading while providing objective numeric grades to measure student performance and generate a class rank. We suggest that faculty evaluation and curricular change require appropriate evaluation methods and continuous quality improvement based on the chosen assessment methodologies. We then summarize how we merge graded and nongraded assessments into a final student evaluation that realistically discriminates among students' performance and present our numeric-to-letter grade conversion table. We conclude that 1) multiple strategies are required, available, and adequate to provide graduates with the numerical GPAs demanded by postdoctoral programs and that 2) continuous quality improvement among all levels of the oral health education community should be vigorously pursued by administration and faculty alike.

Dentist shortage: an analysis of dentists, practices, and populations in the underserved areas.

OBJECTIVES: The objectives of this study are to identify and describe the characteristics of dental underserved geographic areas. Understanding these characteristics is an important step in addressing access to dental care barriers. METHODS: Dental underserved areas were identified from the Health Resources and Services Administration (HRSA) database and converted to census tracts for analysis. Characteristics of dental underserved geographic areas were compared with areas not designated as underserved. Dental practices included in the Dun & Bradstreet Business information database were geocoded and analyzed according to the underserved designation of their location and census demographic data. Thus, the relationships between dental underserved status, practice, and population characteristics were evaluated. RESULTS: Dental underserved areas are more likely to comprise individuals with lower socio-economic status (income and education levels), higher levels of underrepresented population groups, and have lower population densities than non-underserved areas. The populations living in dental underserved areas are more likely to experience geographic, financial, and educational barriers to dental care. CONCLUSIONS: The study identifies the geographic and financial barriers to dental care access. These findings suggest that the likelihood of a market-driven solution to dental underserved geographic areas is low and support public sector interventions to improve the status quo.

Practice Location Characteristics of Non-Traditional Dental Practices.

Current and future dental school graduates are increasingly likely to choose a non-traditional dental practice-a group practice managed by a dental service organization or a corporate practice with employed dentists-for their initial practice experience. In addition, the growth of non-traditional practices, which are located primarily in major urban areas, could accelerate the movement of dentists to those areas and contribute to geographic disparities in the distribution of dental services. To help the profession understand the implications of these developments, the aim of this study was to compare the location characteristics of non-traditional practices and traditional dental practices. After identifying non-traditional practices across the United States, the authors located those practices and traditional dental practices geographically by zip code. Non-traditional dental practices were found to represent about 3.1% of all dental practices, but they had a greater impact on the marketplace with almost twice the average number of staff and annual revenue. Virtually all non-traditional dental practices were located in zip codes that also had a traditional dental practice. Zip codes with non-traditional practices had significant differences from zip codes with only a traditional dental practice: the populations in areas with non-traditional practices had higher income levels and higher education and were slightly younger and proportionally more Hispanic; those practices also had a much higher likelihood of being located in a major metropolitan area. Dental educators and leaders need to understand the impact of these trends in the practice environment in order to both prepare graduates for practice and make decisions about planning for the workforce of the future.

Family violence content in dental hygiene curricula: a national survey.

Dental personnel are in an excellent position to recognize suspected abuse of dental patients because 65-75 percent of abuse occurs in the head and neck area. While most dental and dental hygiene curricula include the topic of child abuse, it has previously been unknown if other types of abuse, such as intimate partner abuse, elder abuse, and abuse of disabled persons, are addressed. This study was conducted to determine the extent to which dental hygiene programs have incorporated these family violence topics into the curriculum. Specific data on content, teaching methods, faculty, and resources were collected. Reasons for not including family violence in the curricula, attitudes on mandatory continuing education, and support services available for abuse victims were also examined. A fifteen-item survey was sent to all 229 U.S. accredited dental hygiene programs. Surveys were returned from 173 programs for a response rate of 77.5 percent. Child abuse was taught in most programs (N=122, 70.5 percent), while elder abuse (N=95, 54.9 percent), intimate partner abuse (N=81, 46.8 percent), and abuse of individuals with disabilities (N=80, 46.2 percent) were taught in fewer programs. Reasons for not including family violence in the curricula (N=31, 18 percent) varied. The need is critical for increased curriculum attention in U.S. dental hygiene programs to help stem the epidemic of family violence. Raising dental hygienists' awareness of the problem and potentially increasing the number of reports of and referrals for suspected violence may help more victims.

Non-graded clinical evaluation of dental students in a competency-based education program.

The objective of this article is to report the development, implementation, and early results of a non-graded normative dental student clinical performance assessment system based on our competencies documents. The normative system (student performance is compared to evidence-based clinical standards) was used and evaluated during the 2002-03 academic year and is now gradually replacing the traditional summative (numerical) grading system previously used at Baylor College of Dentistry. The methodology included: 1) consensus development of new clinical performance assessment forms over the summer of 2002; 2) concurrent fourth-year clinical faculty calibration to the new forms; 3) implementation at the beginning of the senior year for the Class of 2003; and 4) faculty and student evaluation surveys in May 2003. Every step of each clinical procedure was recorded, weekly performance summaries by both students and faculty were collected, and periodic workshops were held to refine the forms and further calibrate faculty. The results showed strong positive responses to the new system by graduates and faculty alike. We conclude that early results warrant broadened efforts toward a continuously improved schoolwide normative student clinical performance assessment system.

Effect of grade point average and enrollment in a dental hygiene National Board review course on student performance on the National Board Examination.

Passing the National Board Dental Hygiene Examination is a requirement for licensure in all but one state. There are a number of preparation courses for the examination sponsored by corporations and dental hygiene programs. The purpose of this study was to determine if taking a board review course significantly affected student performance on the board examination. Students from the last six dental hygiene classes at Baylor College of Dentistry (n = 168) were divided into two groups depending on whether they took a particular review course. Mean entering college grade point averages (GPA), exiting dental hygiene program GPAs, and National Board scores were compared for the two groups using a t-test for independent samples (p < 0.05). No significant differences were found between the two groups for entering GPA and National Board scores. Exiting GPAs, however, were slightly higher for those not taking the course compared to those taking the course. In addition, a strong correlation (0.71, Pearson Correlation) was found between exiting GPA and National Board score. Exiting GPA was found to be a strong predictor of National Board performance. These results do not appear to support this program's participation in an external preparation course as a means of increasing students' performance on the National Board Dental Hygiene Examination.

The past and future evolution of the dental workforce team.

This article looks at changes in the number and mix of providers in the dental workforce over the past sixty years. First, enrollment trends in dental education programs are investigated. These educational programs feed directly into the dental workforce. Then, the changes in the dental workforce are examined. The focus of this investigation is the composition of the dental workforce and how the components of the workforce have changed over time. The forces that are responsible for these changes in the workforce are explored next. Finally, the possibility for workforce changes in the future is considered.

The ethics of live patient use in dental hygiene clinical licensure examinations: a national survey.

A national survey of dental hygienists was conducted to explore ethical issues arising from the use of live patients for dental hygiene clinical licensure examinations. Data were collected regarding respondents' demographics, additional costs they incurred associated with their examination beyond the examination fees, delays in patients' treatment resulting from the examination, unethical candidate and/or patient behaviors they experienced, and provisions they made for patients' follow-up care related to the examination. Five hundred surveys were mailed to dental hygienists from two states in each of the five licensure examination regions. The response rate was 40.6 percent (n=203). Descriptive statistics were used to analyze the data. The results showed that the majority of the respondents spent additional money on examination-related expenses (69.2 percent). Sixty-one percent of the respondents reported paying their patients; however, only 50.5 percent felt such a practice was acceptable. More than half (53.1 percent) reported believing it was appropriate to delay treatment in order to have a patient participate in the examination, although only 16.4 percent reported actually delaying treatment. Informed consent was said to be obtained by 94.9 percent of the respondents. The majority (86.6 percent) said they referred patients for follow-up dental hygiene care. When asked if they felt the examination was an accurate assessment of their clinical skills, 78.7 percent of the respondents agreed that it was.

A comparative study of root defect coverage using an acellular dermal matrix with and without a recombinant human platelet-derived growth factor.

BACKGROUND: The objective of this case series is to compare root defect coverage results and healing responses of bilateral recession defects treated with acellular dermal matrix (ADM) with and without recombinant human platelet-derived growth factor (rhPDGF). METHODS: Seventeen patients with 40 bilateral gingival recession defects were compared. Each defect was ≥2 mm and treated with ADM and a coronally advanced flap. Using split-mouth design, the control-side ADM was hydrated in sterile saline, whereas the test-side ADM was hydrated in rhPDGF. The patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Standardized measurements were taken preoperatively at 3 and 6 months. Healing was clinically assessed at 1 week and 1 month post-surgically. RESULTS: Both test and control groups showed significant gain in root defect coverage over the 6-month period for all individuals, with the test group showing a 69.0% gain and the control group showing a 76.7% gain. Patients divided into Miller Class I and Class III defects were also found to have a significant gain in root defect coverage over 6 months. The test group showed 84.1% gain, and the control group showed 84.7% gain for Miller Class I defects. For Miller Class III defects, the test group showed 51.5% gain, and the control group showed a 60.8% gain. One week after surgery, 35% of the test group showed better healing, whereas 15% of the control group showed better healing. One month after surgery, 20% of the test group showed better healing, whereas 15% of the control group showed better healing. CONCLUSION: Based on the results of this case series, there were no statistically or clinically significant differences in root defect coverage, keratinized tissue, clinical attachment level, or clinical healing for treatment of root recession with a coronally advanced flap and ADM with and without rhPDGF.

Assessment of hemostatic efficacy and osseous wound healing using HemCon dental dressing.

INTRODUCTION: Obtaining hemostasis in the surgical crypt during periradicular surgery is essential. It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material. Although current materials may not be moisture sensitive during setting, hemostasis is important for proper placement of root-end filling materials during apical surgery. A new hemostatic agent, HemCon dental dressing (Patterson Dental, St Paul, MN), may improve upon the efficacy of wound healing and hemostasis both in extent and time. The aim of this study was to evaluate the hemostatic effect of HemCon in osseous wound sites and evaluate the wound healing potential and percentage of new bone formation in osseous crypts treated with HemCon. METHODS: A split-mouth design was used with random allocation of sham and experimental sites in 12 rabbits. In experimental sites, either HemCon or 15.5% ferric sulfate was applied to osseous crypts created with a round bur. Hemostatic efficacy was evaluated using predetermined scores. Rabbits were sacrificed at 21 days, and tissues were harvested and prepared for histologic evaluation. A blinded pathologist scored samples relative to inflammation. The percentage of new bone deposition was calculated using NIS Elements software (Nikon Instruments Inc, Melville, NY). RESULTS: There was no statistical significant difference in hemostatic efficacy or wound healing between HemCon and ferric sulfate (P > .05). The HemCon group showed a significantly higher percentage of new bone deposition compared with the controls (P < .01). CONCLUSIONS: HemCon shows promise as an adjunct to the endodontic surgical armamentarium.