Evidence-based Update of Pediatric Dental Restorative Procedures: Preventive Strategies.

BACKGROUND: There has been significant advances in the understanding of preventive restorative procedures regarding the advantages and disadvantages for restorative procedures; the evidence for conservative techniques for deep carious lesions; the effectiveness of pit and fissure sealants; and the evidence for use of resin infiltration techniques. AIM: The intent of this review is to help practitioners use evidence to make decisions regarding preventive restorative dentistry in children and young adolescents. STUDY DESIGN: This evidence-based review appraises the literature, primarily between the years 1995-2013, on preventive restorative strategies. The evidence was graded as to strong evidence, evidence in favor, or expert opinion by consensus of authors Results: The preventive strategy for dental caries includes individualized assessment of disease progression and management with appropriate preventive and restorative therapy. There is strong evidence that restoration of teeth with incomplete caries excavation results in fewer signs and symptoms of pulpal disease than complete excavation. There is strong evidence that sealants should be placed on pit and fissure surfaces judged to be at risk for dental caries, and surfaces that already exhibit incipient, non-cavitated carious lesions. There is evidence in favor for resin infiltration to improve the clinical appearance of white spot lesions. CONCLUSIONS: Substantial evidence exists in the literature regarding the value of preventive dental restorative procedures.

Water Fluoridation and Dental Caries in U.S. Children and Adolescents.

Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. POPULATION: This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

Use of dental care by HIV-infected medical patients.

Although increasing attention has been paid to the use of dental care by HIV patients, the existing studies do not use probability samples, and no accurate population estimates of use can be made from this work. The intent of the present study was to establish accurate population estimates of the use of dental services by patients under medical care. The study, part of the HIV Cost and Services Utilization Study (HCSUS), created a representative national probability sample, the first of its kind, of HIV-infected adults in medical care. Both bivariate and logistic regressions were conducted, with use of dental care in the preceding 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Forty-two percent of the sample had seen a dental health professional in the preceding 6 months. The bivariate logits for use of dental care show that African-Americans, those whose exposure to HIV was caused by hemophilia or blood transfusions, persons with less education, and those who were employed were less likely to use dental care (p < 0.05). Sixty-five percent of those with a usual source of care had used dental care in the preceding 6 months. Use was greatest among those obtaining dental care from an AIDS clinic (74%) and lowest among those without a usual source of dental care (12%). We conclude that, in spite of the high rate of oral disease in persons with HIV, many do not use dental care regularly, and that use varies by patient characteristics and availability of a regular source of dental care.

1985 NHIS findings on public knowledge and attitudes about oral diseases and preventive measures.

Two objectives for the nation for 1990 set goals related to the need for schoolchildren and adults to understand the causes of oral diseases and methods of prevention. Five questions related to these objectives were included in the 1985 National Health Interview Survey. Survey responses of adults ages 18 years and older indicated that while the public is generally aware of the importance of a number of factors in the prevention of tooth decay, only 18 percent had both heard of, and knew the purpose of, dental sealants. At the same time, the public fails to discriminate between effective disease preventive factors related to periodontal diseases as opposed to those related to dental decay. Knowledge of oral disease prevention modalities generally varies across educational, income, age, and racial categories. However, there appears to be little variation in knowledge by gender. Additional information from upcoming surveys may shed more light on the relationships between knowledge of oral diseases and their prevention and personal preventive practices.

A comparison of dental care expenditures and office-based medical care expenditures, 1987.

BACKGROUND: This article compares national estimates of utilization of and expenditures for dental care and office-based medical care. The comparison includes respondents in several socioeconomic and demographic categories. METHODS: The focus of the analyses is on dental care and office-based medical care utilization during 1987. Specifically, the authors provide national estimates for numbers of dental and office-based medical visits made, expenditures for and sources of payment for each of several socioeconomic and demographic categories using household survey data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: Data show that out-of-pocket expenditures are greater for dental care than for office-based medical care; that few Medicaid dollars are spent on dental care; that insurance is an important component of dental and office-based medical care; and that dentists provide greater amounts of unreimbursed care than do their office-based physician counterparts. CONCLUSIONS: NMES data show that dental care expenditures are considerable, almost as large as expenditures for office-based medical care, and are a significant component of all nonhospital health care expenditures for noninstitutionalized Americans. PRACTICE IMPLICATIONS: U.S. dentists provide a significant amount of care. By understanding these analyses, practitioners will be better positioned to provide care and to better meet the dental needs of all Americans.

Dental services. An analysis of utilization over 20 years.

BACKGROUND: Utilization studies serve as an important tool for oral health policy decision-making. A number of important reports have been published that help to characterize the dental utilization patterns of most Americans. For the most part, these studies have focused on utilization estimates for a particular survey period or year. Fewer studies have examined changing utilization patterns over time. METHODS: This article focuses on dental utilization and the changes in utilization for the civilian, community-based U.S. population during 1977, 1987 and 1996. Using data from the National Medical Care Expenditure Survey, National Medical Expenditure Survey and Medical Expenditure Panel Survey, the authors provide national estimates of dental visits for each of several socioeconomic and demographic categories during 1977, 1987 and 1996. RESULTS: Although the dental use rates for children between 6 and 18 years of age were the highest of any age group in each of the three years studied, the use rate for children and the elderly increased during this same 20-year period. Data also showed that the gap in use rates between lower- and higher-income people widened during the 20-year period. Generally, use rates according to sex and race/ethnicity were unchanged in each of the survey years, except for a narrowing of the gap between whites and nonwhites by 1996. CONCLUSION: These data are unique and comparable and establish a mechanism by which dental visits can be compared during a 20-year period. While aggregate utilization rates generally were stable during this 20-year period, some differences within socioeconomic and demographic groups are notable. For instance, the use rate increased during the 20-year period for people 65 years of age and older and for children younger than 6 years of age. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and meet the needs of all Americans.

Dental services: use, expenditures and sources of payment, 1987.

BACKGROUND: This article provides per capita estimates of dental care utilization, expenditures, mix of services and sources of payment for each of several socioeconomic and demographic categories. METHODS: The focus of the analyses presented here is on dental care utilization by the U.S. population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. CONCLUSIONS: These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. PRACTICE IMPLICATIONS: Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses, practitioners will be better positioned to meet the dental needs of all Americans.

Health services research, the Agency for Health Care Policy and Research, and Dental Practice.

Recent findings of research supported by the Agency for Health Care Policy and Research (AHCPR) confirm the need for additional health services research on the effectiveness and appropriateness of dental care, and the way in which dental care is provided and financed. This paper presents an overview of relevant AHCPR programs, gives examples of dental health services research supported by the Agency, and describes ways in which Fellows of the American College of Dentists could participate in the development and dissemination of health services research. New knowledge generated by dental health services research will be useful to dentists in meeting many of their professional obligations. Translating that knowledge into improved quality of care will depend directly upon the best collaborative efforts of dentists in all professional settings and may include collaboration with academic researchers. As leaders in the profession, Fellows of the American College of Dentists are regarded as instrumental in conveying the findings of health services research to their colleagues, stimulating critical review, and making recommendations to guide research in the future.

Perceived unmet need for oral treatment among a national population of HIV-positive medical patients: social and clinical correlates.

OBJECTIVES: This study examines social, behavioral, and clinical correlates of perceived unmet need for oral health care for people with HIV infection. METHODS: Baseline in-person interviews with 2864 individuals were conducted with the HIV Cost and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected persons in medical care. Bivariate and logistic regression analyses were conducted, with unmet need in the last 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. RESULTS: We estimate that 19.3% of HIV-infected medical patients (n = 44,550) had a perceived unmet need for dental care in the last 6 months. The odds of having unmet dental needs were highest for those on Medicaid in states without dental benefits (odds ratio [OR] = 2.21), for others with no dental insurance (OR = 2.26), for those with incomes under $5000 (OR = 2.20), and for those with less than a high school education (OR = 1.83). Low CD4 count was not significant. CONCLUSIONS: Perceived unmet need was related more to social and economic factors than to stage of infection. An expansion of dental benefits for those on Medicaid might reduce unmet need for dental care.