Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program.

INTRODUCTION: Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities. METHODS: Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015. RESULTS: In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively). CONCLUSIONS: Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.

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.

Analysis of patient factors impacting duration of periodontal maintenance appointments: an exploratory study.

PURPOSE: The periodontal maintenance (PM) appointment requires varying amounts of time and is absolutely essential for long-term successful periodontal therapy. This study assessed time requirements for PM and relative contribution of patient-level factors such as oral health status, complex medical history, maintenance compliance and demographics. METHODS: One hundred patients receiving PM in a graduate periodontal program at a dental school participated in this cross sectional, observational study and components of their PM were timed in minutes/seconds. Descriptive data were obtained for average total-time required for PM and relative time for each treatment component. Hierarchical multiple linear regression determined what patient-level factors demonstrated the greatest impact on total-time to complete PM. RESULTS: The average PM appointment interval, with radiographs, was 1 hour, 16 minutes, 23 seconds (SD 19:25 minutes). When cubicle preparation and disinfection was included, the total-time was 1 hour, 24 minutes, 31 seconds (±19:32 minutes). Multiple regression showed that BOP, dentist examinations, number of carious lesions and/or restorative defects, number of teeth/implants, taking radiographs, female gender and deposit aggregate (supragingival and subgingival calculus and stain) were significant predictors of total PM duration and explained 57% variance (p<0.05, R2=0.569). CONCLUSION: Based on the average comprehensive PM appointment time of 1:16 minutes, the typical appointment of 60 minutes is insufficient to achieve the goals of a comprehensive PM in this academic clinic setting. These findings suggest the need to utilize more customized models for scheduling PM in order to achieve time allocations that are individualized to address specific patients' needs.

Coffee consumption and periodontal disease in males.

BACKGROUND: Coffee is a major dietary source of antioxidants as well as of other anti-inflammatory factors. Given the beneficial role of such factors in periodontal disease, whether coffee intake is associated with periodontal disease in adult males was explored. METHODS: Existing data collected by a prospective, closed-panel cohort study of aging and oral health in adult males was used. Participants included the 1,152 dentate males in the Veterans Affairs (VA) Dental Longitudinal Study who presented for comprehensive medical and dental examinations from 1968 to 1998. Mean age at baseline was 48 years; males were followed for up to 30 years. Participants are not VA patients; rather, they receive their medical and dental care in the private sector. Periodontal status was assessed by probing depth (PD), bleeding on probing, and radiographic alveolar bone loss (ABL), measured on intraoral periapical radiographs with a modified Schei ruler method. Moderate-to-severe periodontal disease was defined as cumulative numbers of teeth exhibiting PD ≥4 mm or ABL ≥40%. Coffee intake was obtained from participant self-reports using the Cornell Medical Index and food frequency questionnaires. Multivariate repeated-measures generalized linear models estimated mean number of teeth with moderate-to-severe disease at each examination by coffee intake level. RESULTS: It was found that higher coffee consumption was associated with a small but significant reduction in number of teeth with periodontal bone loss. No evidence was found that coffee consumption was harmful to periodontal health. CONCLUSION: Coffee consumption may be protective against periodontal bone loss in adult males.

Does a case completion curriculum influence dental students' clinical productivity?

The purpose of this study was to evaluate the effects of a new clinical curriculum on dental student productivity as measured by number of procedures performed in the student teaching practice. Harvard School of Dental Medicine adopted a new clinical education model for the predoctoral program in summer 2009 based upon a Case Completion Curriculum (CCC) rather than a discipline-based numeric threshold system. The two study groups (threshold group and case completion group) consisted of students who graduated in 2009 and 2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative dentistry, removable prosthodontics, fixed prosthodontics, and endodontics. The relationships between the two study groups with regard to number of procedures performed by category revealed that the case completion group performed a significantly higher number of operative and removable prosthodontic procedures, but fewer periodontal and endodontic procedures (p≤0.03). No statistically significant difference in number of procedures was observed with fixed prosthodontic procedures between the two groups. Clinical productivity as a result of redesigning the clinical component of the curriculum varied in selected disciplines. The CCC, in which the comprehensive management of the patient was the priority, contributed to achieving a patient-based comprehensive care practice.

A comparison of dental service use among commercially insured women in Minnesota before, during and after pregnancy.

BACKGROUND: The authors examined and compared dental services used by women before, during and after pregnancy. METHODS: In their study, the authors combined medical and dental claims data for 3,462 pregnant women in Minnesota with commercial dental insurance who had been pregnant between Jan. 1, 2004, and Dec. 31, 2005. The authors used McNemar pairwise comparisons, with each subject serving as her own control and her use of various dental services before pregnancy as her own baseline, to evaluate and compare the dental services used during and after pregnancy. RESULTS: During pregnancy, subjects' use of several dental services-radiographs, restorative services, third-molar extractions and anesthesia-decreased significantly (P < .001) in comparison with their prepregnancy use. After pregnancy, subjects' use of checkups, radiographs and restorative services showed significant increases (P < .001). CONCLUSIONS: The significant decreases in use of these services during pregnancy and significant increases after pregnancy may suggest that these women and their dentists were using these services only conservatively during pregnancy or postponing their use altogether until after delivery. CLINICAL IMPLICATIONS: This study's findings may provide useful background information to medical and dental providers, health care plan administrators and policymakers as they consider recommendations regarding oral health care for women during pregnancy.

Modalidades terapéuticas odontológicas recibidas por el paciente anciano / Dental therapeutic modalities for the aged patient

Fueron interrogados 100 pacientes de ambos sexos, mayores de 60 años, con el objeto de identificar los alcances terapéuticos que ha tenido la odontología institucional y/o privada en relación al tipo de tratamiento que ha recibido este grupo de estudio, conocer la importancia que el paciente geriátrico le da al tratamiento odontológico integral y los factores que influyen en ello. El 52 por ciento de la muestra estudiada nunca recibió información sobre los problemas que pueden tener en la boca y el 66 por ciento no fue informado sobre las necesidades de tratamiento. Las principales actividades terapéuticas que recibieron fueron exodoncia, operatoria y periofoncia (profilaxis). El 45 por ciento de los pacientes mayores de 60 años acude solamente por presentar dolor. Declararon no asistir al odontólogo por carecer de recursos económicos, por no tener dolor, y por considerarlo un lujo o tener miedo

The oral health care programme of Cartaxo. Assessment of its impact.

The Cartaxo Municipality has been developing a primary oral health care program since 1988. It is based on national programs of oral health promotion and prevention of dental caries (Oral Health Technical Guidelines on Mother & Child Health and Oral Program in Schools) of the Primary Health Care Administration, and includes the application of pit and fissure sealants on the occlusal surface of the first permanent molars of school children aged 6-7 years. The purpose of this study is to divulge the evaluation of the impact of this program on the dental health of the population studied.