Cognitive impairment and edentulism among older adults: an observational study using claims data.

BACKGROUND: The scientific link between mastication strength and cognitive function has not yet been strongly corroborated in population studies. Utilizing large-scale claims, we aim to investigate the association between edentulism and cognitive impairment in older American adults. METHODS: Using de-identified claims from a commercial insurer from 2015-2019, we conducted a retrospective cohort study using multilevel regression models to evaluate the association between denture status and clinically diagnosed cognitive impairment. Secondary analysis included symptomatic cognitive impairment in the outcome. RESULTS: Adjusting for individual-level risk factors, denture status was significantly associated with clinical cognitive impairment with odds ratios of 1.13 (95%CI: 1.02-1.25) and 1.26, (95%CI: 1.09-1.45) for complete dentures on one or both jaws, respectively. Including symptomatic cognitive impairment in the analysis did not substantially change our fundamental findings. CONCLUSION: Prevention and treatment of oral diseases should be considered a key component in preserving the overall wellness of older adults.

Association between maternal periodontal disease and adverse pregnancy outcomes: an analysis of claims data.

BACKGROUND: While a number of studies have explored the link between periodontal disease and adverse pregnancy outcomes, both epidemiological studies and intervention trials have reached contradictory results with relatively small sample sizes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. OBJECTIVE: Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. METHODS: Using de-identified claims data from a national commercial insurer in the USA, records of all observed pregnancies from 2015 to 2019 were included in this retrospective cohort study. Adverse pregnancy outcomes, including low birthweight (LBW) of the newborn, preterm birth (PTB) and spontaneous abortion, were primary outcomes. To evaluate the association between periodontal disease and pregnancy outcomes, logistic mixed-effect model was estimated with periodontal disease status, age, existing clinical conditions of mothers and geographic location as covariates. RESULTS: Out of 748 792 observed pregnancy records, 18.66% resulted in adverse pregnancy outcomes; 5.92% in LBW, 14.46% in PTB and 2.22 % in spontaneous abortion. Adjusting for individual-level risk factors, periodontal disease was significantly associated with maternal complications with odds ratios of 1.19 (95% CI:1.15, 1.24) for any adverse pregnancy outcomes, 1.10 (95% CI:1.03, 1.17) for LBW, 1.15 (95% CI:1.10, 1.19) for PTB and 1.34 (95% CI:1.23, 1.46) for spontaneous abortions. CONCLUSIONS: Maternal periodontal disease may be associated with an increased risk of maternal complications and neonatal morbidity. A timely diagnosis and treatment of periodontal disease during pregnancy should be encouraged by considering oral health as part of routine prenatal care.

Training and educational programs that support geriatric dental care in rural settings: A scoping review.

PURPOSE/OBJECTIVES: Access to dental care for older adults is challenging, especially for those living in rural areas. People living in rural areas are less likely to visit the dentist, have greater oral health needs, and face significant oral health disparities. Given the projected increase in the older adult population, the aim of this study was to conduct a scoping review (SR) to identify the current landscape of geriatric dental training in rural healthcare settings. METHODS: Four guiding concepts (i.e., dental workforce, education/training, rural setting, and older adult population) were searched in PubMed, Embase (Elsevier), Dental and Oral Sciences Source (EBSCO), and ERIC (EBSCO) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EndNote and Covidence were used for de-duplication algorithms and title/abstract screening. RESULTS: Seventy-nine citations were identified for the final full-text review based on inclusion and exclusion criteria, and ten articles were eligible for data extraction as applicable to the research question. Three themes emerged from the review: geriatric dentistry inclusion within dental school curricula, clinical training at rural/remote locations, and improving geriatric oral health knowledge through interprofessional training. CONCLUSION: This SR highlights the limited number of currently trained geriatric dentists, as well as, the paucity of dental programs/curricula offered to produce competent dental geriatricians with an advanced skill set for practicing in rural settings. Our review indicates the need to expand the dental workforce, curricula, and training to better position dentists to serve the older and underserved population in rural and remote areas.

Pandemic preparedness in dental education: A US-based national survey.

OBJECTIVES: The Coronavirus Disease-19 (COVID-19) pandemic highlighted the need for pandemic preparedness (PP) in health professions training. We aimed to (1) establish a current profile on curricular content of PP in US dental schools and (2) examine how schools were adapting their curricula in response to COVID-19. METHODS: An online survey was developed and sent to senior leadership to all 66 Commission on Dental Accreditation (CODA)-accredited US dental schools including Deans of Academic or Clinical Affairs from November 2020-February 2021. Questions addressed PP curricular content, teaching methods, and evaluation. Participants were asked about the barriers and facilitators for the inclusion of this content. The survey also included questions on redeployment of the clinical workforce in response to the pandemic. RESULTS: The response rate was 31.8% (n = 21) with representation from every US Census Bureau-designated division. While all responding dental schools agreed that dental professionals can play an important role during pandemics, 38.1% reported including content on PP into their pre- or postdoctoral curriculum. In response to the COVID-19 pandemic, approximately 47.6% indicated redeployment of their clinical workforce to participate in disaster life support, assisting physicians in COVID-19 cases, and assisting hospitals with personal protective equipment (PPE). CONCLUSION: There was general agreement that dental professionals can play an important role during pandemics. The participating US dental schools responded to the COVID-19 pandemic by integrating novel clinical activities. More efforts are required to include PP in dental education.

Oral health outcomes among adults with diabetes served at HRSA-funded health centers.

OBJECTIVES: To examine the association of diabetes with tooth loss and oral manifestations among adult health center patients (HCPs). METHODS: This cross-sectional study utilized the nationally representative 2014 HCPs-Survey. Descriptive and logistic regression analyses limited to adults (n = 5524) were used to compare self-reported responses of tooth loss and oral manifestations (i.e., loose teeth, bleeding gums, mouth sores, and dry mouth) among HCPs with and without diabetes. RESULTS: Almost a quarter of the HCPs reported having diabetes. Among patients with diabetes, more than half were 45-64 years old, had low-income status, and attended rural health centers. Analyses revealed that diabetes was significantly associated with permanent tooth loss and presence of at least one oral manifestation after controlling for confounders. Among adults with diabetes, probability of "missing at least one tooth." were two times higher compared to not missing any teeth [AOR = 2.10, (95%CI 1.40-3.16); P ≤0.001]. Adults with diabetes had higher odds of having one or more "oral manifestations" compared to adults without diabetes [AOR = 1.60, (95%CI 1.22-2.11); P = 0.001]. CONCLUSION: Diabetes disproportionately affects HCP adults (23%) compared to the general U.S. adult population (10%). In HCPs having diabetes was associated with a higher prevalence of oral manifestations (i.e., loose teeth, bleeding gums) and losing "At least one" of their permanent teeth. These findings suggest that adults with diabetes had higher prevalence of oral manifestations and tooth loss, highlighting the need for innovative interprofessional models for early screening and identification.

Changes in dental care use patterns due to COVID-19 among insured patients in the United States.

BACKGROUND: Demand for dental services has been known to be linked closely to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to COVID-19 thus may have a significant impact on dental care use. METHODS: Using deidentified dental practice management data from 2019 and 2020, the authors observed variations in dental care use among insured patients since the COVID-19 outbreak (during the period of practice closure and after the reopening) by patient age, procedure type, insurance type, practice size, geographic area, and reopening status. The authors examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models. RESULTS: Although dental care use among privately insured patients fully rebounded by August 2020, use still remained lower than the prepandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased 60-fold during practice closure. Geographic characteristics-such as median household income, percentages of rural or Black populations, and dental care professional shortage designations-were associated significantly with the number of procedures performed at dental practices. CONCLUSIONS: As a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particularly among patients covered by public insurance or residing in underserved areas. PRACTICAL IMPLICATIONS: During economic downturns, state health officials should be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or midlevel dental care providers in underserved areas.

Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices.

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were -$92,053 (95% CI: -93,054, -91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

A Case Study Optimizing Human Resources in Rwanda's First Dental School: Three Innovative Management Tools.

Harvard School of Dental Medicine, University of Maryland School of Dentistry, and the University of Rwanda (UR) are collaborating to create Rwanda's first School of Dentistry as part of the Human Resources for Health (HRH) Rwanda initiative that aims to strengthen the health care system of Rwanda. The HRH oral health team developed three management tools to measure progress in systems-strengthening efforts: 1) the road map is an operations plan for the entire dental school and facilitates delivery of the curriculum and management of human and material resources; 2) each HRH U.S. faculty member develops a work plan with targeted deliverables for his or her rotation, which is facilitated with biweekly flash reports that measure progress and keep the faculty member focused on his or her specific deliverables; and 3) the redesigned HRH twinning model, changed from twinning of an HRH faculty member with a single Rwandan faculty member to twinning with multiple Rwandan faculty members based on shared academic interests and goals, has improved efficiency, heightened engagement of the UR dental faculty, and increased the impact of HRH U.S. faculty members. These new tools enable the team to measure its progress toward the collaborative's goals and understand the successes and challenges in moving toward the planned targets. The tools have been valuable instruments in fostering discussion around priorities and deployment of resources as well as in developing strong relationships, enabling two-way exchange of knowledge, and promoting sustainability.

Building oral health research infrastructure: the first national oral health survey of Rwanda.

BACKGROUND: Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions. OBJECTIVE: To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies. METHODS: In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument. RESULTS: Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively. CONCLUSION: The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management strategies as well as oral health workforce and infrastructure.

Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda.

A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.