Validation of a Two-Item Food Security Screening Tool in a Dental Setting.

Purpose: The United States is typically viewed as a wealthy country, yet not all households have access to enough food for an active, healthy life. The purpose of this study was to validate a two-item written food security screen that health providers may use to identify food insecurity in their patient populations.Methods: Data were obtained from 150 parents or guardians who brought a child to a dental appointment at The Center for Pediatric Dentistry, University of Washington, Seattle, Wash., USA. The sensitivity and specificity of two written questions were determined by comparing with the United States Department of Agriculture Six-item Short Form of the Food Security Survey Module.Results: The sample consisted of 141 surveys after those with critical questions left blank were removed. The prevalence of food insecurity was found to be 31 percent at the Center for Pediatric Dentistry. The six-item screen identified 44 foodinsecure families with an affirmative response to two or more questions. Compared with the six-item screen, the two-item screen was found to have 95.4 percent sensitivity and 83.5 percent specificity.Conclusions: The two-item food security screen was found to be sensitive and reasonably specific, providing a quick and accurate method to identify food-insecure families.

Parent, Dentist, and Independent Rater Assessment of Child Distress During Preventive Dental Visits.

PURPOSE: Although typically not painful, preventive dental care can be distressing to young children. A greater understanding of how adults perceive child distress may enable clinicians to improve the patient/parent experience through alignment of values and facilitation of shared decision-making. The purpose of this study was to examine the association between parent, dentist, and independent observer (IO) ratings of child distress during preventive dental procedures. METHODS: Sixty-five children younger than three years were seen for preventive dental care at a university dental clinic. Parents, dentists, and an IO rated intensity of child distress during four phases of the dental visit: (1) pre-exam; (2) positioning; (3) prophylaxis/exam/fluoride; and (4) post-exam. RESULTS: The average age of the children was 24.4 months old (±7.2 SD). The prophylaxis/exam/fluoride phase was judged to be most distress inducing. Mean distress ratings for this phase were: 2.30 (parents); 2.47 (dentists); and 3.08 (IO), which was statistically significant (P=.04). The IO ratings were significantly different from parents (for three phases) and dentists (for one phase); no statistically significant differences were noted between parent and dentist ratings for any phase. CONCLUSIONS: There was a strong agreement between parents' and dentists' ratings of child distress during preventive dental procedures.

Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children.

PURPOSE: The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children. METHODS: This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. RESULTS: In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, P<.05). CONCLUSIONS: There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.