Adoption and implementation of policies to support preventive dentistry initiatives for physicians: a national survey of Medicaid programs.

OBJECTIVES: We determined the number of state Medicaid programs adopting initiatives to support preventive dental services provision by nondental health care professionals, their perceived attributes, and implementation barriers. METHODS: We used Qualtrics to conduct a cross-sectional survey in 2008 of Medicaid dental program managers to determine organizational stage of adoption classified according to the Transtheoretical Model of Behavior Change with 3-year follow-up. We assessed perceptions of the influence of 18 initiative attributes on the decision to adopt, drawn from Roger's diffusion of innovations theory. Stage and date of adoption are presented descriptively. Attributes and barriers were analyzed by stage of adoption by using analyses of variance or χ(2) statistics. RESULTS: By 2011, 42 states had adopted a policy. Only 9 states included a comprehensive set of preventive services, the most common being fluoride varnish. Adoption was affected by perceived initiative simplicity and its compatibility with other Medicaid programs. Administrative barriers were the most common among the 15 studied. CONCLUSIONS: State Medicaid policies to reimburse nondental providers for preventive dental services are becoming widespread. Interventions are needed to ensure oral health services delivery at the practice level.

Drinking Water Practices Among Latino Families in North Carolina: A qualitative study.

Purpose: The purpose of this study was to understand the beliefs, experiences and practices regarding drinking water among the North Carolina (NC) Latino community, and to gather information on what would make effective messages to promote fluoridated community water (CW) consumption among Latino families.Methods: Phone interviews were conducted with Latino stakeholders, consisting of parents of young children and key community informants (n=15). The interviews were audio-recorded, and transcripts were analyzed qualitatively using Atlas. ti.8 software.Results: Major themes emerging from the interviews included: poor characteristics of CW misconceptions and lack of knowledge about CW fluoridation and safety, ingrained culture/upbringing that devalued CW consumption, and reasons for consuming CW. Participants suggested that effective efforts to promote fluoridated CW consumption among the NC Latino community should be implemented in a variety of formats and involve a collaborative approach between Spanish-speaking health professionals and community workers.Conclusion: Successful promotion of fluoridated CW consumption among NC Latino communities requires engagement of both health professionals and community stakeholders. Effective interventions aimed to promote fluoridated CW consumption need to be widespread, informative, persuasive, credible, culturally sensitive, and interactive.

Trends and determinants of drinking water practices among North Carolina children.

OBJECTIVES: To identify trends and determinants of drinking water practices [bottled (BW) versus community water (CW) consumption] among families of pediatric patients presenting to an academic dental institution over 15 years. METHODS: Electronic health record data were obtained for all first-time routine-care patients ages 0-16 presenting to UNC-Chapel Hill's Pediatric Dentistry Clinics from 2002 to 2016, including families' primary drinking water source and patient demographics (e.g., age, gender, residence, insurance status). Data analyses included descriptive and bivariate methods and multivariable modeling using a P < 0.05 statistical significance criterion. RESULTS: BW consumption has increased over time, from 17 percent in 2004 to 42 percent in 2016 (n = 2,920; P < 0.05). Medicaid-enrolled children [prevalence ratio (PR) = 2.1; 95% confidence interval (CI) = 1.8-2.4] and residents of rural counties (PR = 1.3, 95% CI = 1.1-1.5) were significantly more likely to consume BW versus CW. CONCLUSIONS: BW consumption among NC children has been increasing and is most prevalent among low-income families and in rural areas.

Enhancing Allied Dental Health Students' Understanding of Poverty through Simulation.

Purpose: Poverty impacts the daily lives of over 40 million Americans. Allied dental health students need to be aware of the oral health barriers experienced by individuals with limited resources. The purpose of this exploratory descriptive study was to evaluate the impact of a poverty simulation exercise (PSE) on students' understanding of daily challenges faced by low-income families.Methods: A total of 34 second-year dental hygiene students and 23 dental assisting students (n=57) participated in a 3-hour Missouri Association for Community Action poverty simulation exercise (PSE). Participants completed a survey immediately following the PSE to determine the degree of change in understanding challenges faced by low-income families. Upon completion of all scheduled community practicum/rotations, participants completed a second survey exploring whether the PSE changed their levels of understanding of the challenges faced by actual low-income families and their impact on oral health.Results: Fifty-five dental hygiene and dental assisting students completed both surveys for a response rate of 96% (n=55). A majority of the respondents (87%, n=46) rated the PSE as extremely valuable in preparing them to understand challenges faced by low-income families and 85% (n=47) indicated encountering families living in situations similar to their role in the PSE. A majority of participants (89% n=48) indicated having a better understanding of how poverty effects oral health status and its impact on access to dental care. In addition, students indicated that they became less judgmental and more empathetic toward low-income families.Conclusions: Results from this study demonstrate that a PSE was effective in eliciting change in allied dental health students' affective perceptions regarding poverty and helped improve their understanding of challenges faced by low-income populations.

Enhancing Dental Students' Understanding of Poverty Through Simulation.

Dental students should develop an understanding of the barriers to and frustrations with accessing dental care and maintaining optimal oral health experienced by persons with limited resources rather than blaming the patient or caregiver. Developing this understanding may be aided by helping students learn about the lives of underserved and vulnerable patients they will encounter not only in extramural rotations, but throughout their careers. The aim of this study was to determine if dental students' understanding of daily challenges faced by families with low income changed as a result of a poverty simulation. In 2015 and 2016, an experiential poverty simulation was used to prepare third-year dental students at one U.S. dental school for their upcoming required community-based rotations. In 2015, United Way staff conducted the simulation using the Missouri Community Action Poverty Simulation (CAPS); in 2016, faculty members trained in CAPS conducted the simulation using a modified version of the tool. In the simulation, students were assigned to family units experiencing various types of hardship and were given specific identities for role-playing. A retrospective pretest and a posttest were used to assess change in levels of student understanding after the simulation. Students assessed their level of understanding in five domains: financial pressures, difficult choices, difficulties in improving one's situation, emotional stressors, and impact of community resources for those living in poverty. The survey response rates in 2015 and 2016 were 86% and 74%, respectively. For each of the five domains, students' understanding increased from 58% to 74% per domain. The majority reported that the exercise was very valuable or somewhat valuable (74% in 2015, 88% in 2016). This study found that a poverty simulation was effective in raising dental students' understanding of the challenges faced by low-income families. It also discovered that framing the issues in the context of accessing dental care was important.

Training Requirements and Curriculum Content for Primary Care Providers Delivering Preventive Oral Health Services to Children Enrolled in Medicaid.

BACKGROUND AND OBJECTIVES: Despite the emphasis on delivery of preventive oral health services in non-dental settings, limited information exists about state Medicaid policies and strategies to educate practicing physicians in the delivery of these services. This study aims to determine: (1) training requirements and policies for reimbursement of oral health services, (2) teaching delivery methods used to train physicians, and (3) curricula content available to providers among states that reimburse non-dental providers for oral health services. METHODS: Using Web-based Internet searches as the primary data source, and a supplemental e-mail survey of all states offering in-person training, we assessed training requirements, methods of delivery for training, and curriculum content for states with Medicaid reimbursement to primary care providers delivering preventive oral health services. RESULTS of descriptive analyses are presented for information collected and updated in 2014. RESULTS: Forty-two states provide training sessions or resources to providers, 34 requiring provider training before reimbursement for oral health services. Web-based training is the most common CME delivery method. Only small differences in curricular content were reported by the 11 states that use in-person didactic sessions as the delivery method. CONCLUSIONS: Although we found that most states require training and curricular content is similar, training was most often delivered using Web-based courses without any additional delivery methods. Research is needed to evaluate the impact of a mixture of training methods and other quality improvement methods on increased adoption and implementation of preventive oral health services in medical practices.

Framing Young Childrens Oral Health: A Participatory Action Research Project.

BACKGROUND AND OBJECTIVES: Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community. METHODS: This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software. FINDINGS: Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources. CONCLUSIONS: Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.

Dental and allied dental students' attitudes towards and perceptions of intraprofessional education.

Interprofessional and intraprofessional learning opportunities in health professions education are vital to emphasize evidence-based practice, quality improvement, and cost-effectiveness in patients' oral health care. The aim of this study was to assess dental, dental hygiene, and dental assisting students' readiness for intraprofessional education and to evaluate their attitudes towards and perceptions of intraprofessional teamwork, communication, respect, and understanding of professional roles. In 2013, students at one dental school (N=247) were surveyed, and focus groups were conducted for this convergent parallel mixed-methods study. Survey response rates were as follows: senior dental students 54.4% (N=43), senior dental hygiene students 100% (N=32), dental assisting students 95% (N=19), junior dental students 51.8% (N=42), and junior dental hygiene students 100% (N=33). The results showed that the dental hygiene students had more positive responses about intraprofessional education than the dental and dental assisting students (p<0.05). Most (94%, N=160) of the respondents in the combined groups agreed that intraprofessional learning would help them become more effective members of the oral health care team. The three focus group sessions (N=17) revealed consistency among the groups regarding the value of an integrated clinical design and intraprofessional education. These students were eager and positive about intraprofessional learning and agreed that a shared learning model can improve communication and respect among team members, provide a better understanding of roles, and ultimately enhance patient care.