Impact of Reduced Operating Room Access on Dental Departments in Children's Hospitals.

Purpose: Access to hospital operating rooms (HORs) for pediatric dental patients worsened with the COVID-19 pandemic. The purpose of this study was to assess the impact of hospital operating room denials for dental patients on service and teaching missions in selected US children's hospitals (CHs). Methods: A 12-question online survey was sent to administrative heads of 34 CH dental departments. Results: Twenty-two surveys were completed. All respondent CHs were engaged in pediatric dentistry training. The majority (68 percent) reported that access to HORs worsened since 2017, resulting in longer wait times for hospital dental service cases (82 percent), decreased ability to achieve and maintain oral health for special needs patients (64 percent), more caries-related emergency department visits (50 percent), and delays in medical surgery for children needing dental clearance (45 percent). A quarter (27 percent) reported HOR availability somewhat affected resident training. Conclusion: Lack of access to hospital operating rooms in training hospitals had a negative impact on the quality and timeliness of care and the quality of training.

Denial of Operating Room Access for Pediatric Dental Treatment: A National Survey.

Purpose: U.S. pediatric dentists require access to hospital operating rooms (ORs) to deliver safe and effective dental care to some children but have reported denial of access to ORs for general anesthesia (GA), causing long waiting times, deferral of medically necessary dental care, and unmeasured pain and anxiety for patients. The purpose of this pilot study was to examine the extent and possible underlying causes of operating room access denial. Methods: Public policy advocates (PPAs) of the American Academy of Pediatric Dentistry completed a written or electronic questionnaire about state-specific OR denials during March 2020. Results: Responses from 50 states and the District of Columbia showed 34 PPAs (67 percent) acknowledging OR access problems, with 14 out of 34 (41 percent) reporting a moderate or major problem. Western district PPAs reported the fewest states affected (four out of 11; 36 percent). Hospitals and reimbursement emerged as frequent foci for denials in comment analysis. Conclusions: Operating room access denial is a problem for pediatric dentists in the majority of U.S. states and the District of Columbia; in those states reporting it as a problem, it was considered moderate or major in significance by almost half.

Pediatric Dentists' Attitudes, Perceptions, and Experience with the Affordable Care Act.

PURPOSE: Pediatric oral health benefits were designated as one of 10 Essential Health Benefits (EHB) in the Affordable Care Act. Although it provided coverage for many children, several issues prevent its success. The purpose of this study was to document experience with, attitudes toward, and perceptions of the Affordable Care Act (ACA) among pediatric dentists. METHODS: The study was conducted using a survey consisting of nine multiple choice questions and one open-ended item and was distributed electronically in November 2015 to active and life members of the American Academy of Pediatric Dentistry. RESULTS: Respondents reported patients deferring treatment due to high out-of-pocket costs. Providers perceive that patients do not have enough information to understand their benefits. Providers reported not having enough information to understand how these benefits affect their practices. CONCLUSIONS: Pediatric dentists report deferral of both preventive and restorative care due to high out-of-pocket costs. Pediatric dentists do not feel they have adequate information regarding the Affordable Care Act and its effect on their practices. The majority of pediatric dentists believe that parents have difficulty understanding their children's benefits.

Strengthening the American Academy of Pediatric Dentistry's Public Policy Advocate Network: Identifying Advocacy Efforts and Recommendations.

PURPOSE: The purposes of this study were to collect information on involvement, training, and barriers to participation in advocacy efforts for Public Policy Advocates (PPAs) of the American Academy of Pediatric Dentistry (AAPD) and make recommendations to the AAPD. METHODS: Preliminary data were collected from the PPAs during structured AAPD program meetings, conference calls, and individual interviews. Based on these data, a survey was created, piloted, and sent electronically to all PPAs. Data were analyzed and collated by frequencies. RESULTS: Responses from 38 PPAs (100 percent) revealed they were involved with state legislatures and state chapters of the AAPD and American Dental Association. Eighty-two percent of the PPAs requested additional public policy training and clearer communication channels within the network. PPAs are funding their own advocacy efforts, and the time and resources spent away from patient care is a financial barrier. CONCLUSIONS: The Public Policy Advocate network holds a broad policy skill set and voluntarily commits time and resource to advocate for the support of the pediatric dental patient at state and federal government levels. The American Academy of Pediatric Dentistry can strengthen the PPA's self-directed leadership role at state and federal levels through formalized training, restructuring of the network, and increased resources.

Demographics and quality profile of applicants to pediatric dentistry residencies.

PURPOSE: The purpose of this study was to use Postdoctoral Application Support Service (PASS) data to study the quality and demographic trends for pediatric dentistry residency applicants. METHODS: PASS data on grade point average (GPA) and National Dental Board Exam, Part I (NBI) scores were used to determine applicant quality. PASS demographic data included: (1) gender; (2) citizenship; (3) ethnicity; (4) previous practice of dentistry; and (5) completion of a residency or internship. RESULTS: GPAs showed a significant increase for the 6 years investigated. NBI scores also indicated a significant increase. Significantly more females than males applied to pediatric dentistry residencies. A significant increase in US/Canadian applicants was found. Ethnicity was similar to that of dental school graduates, with minor exceptions. In several of the years studied, there were significant differences in applicants who previously practiced dentistry or completed a residency/internship vs applicants who had no such previous experience. CONCLUSIONS: Significant increases in grade point averages and National Dental Board Exam, Part I scores suggest a high quality of pediatric dentistry residency applicants and this trend seem to be continuing. There are significantly more female than male applicants. More research is warranted on actual acceptance data.

The Affordable Care Act and Health Insurance Exchanges: Advocacy Efforts for Children's Oral Health.

PURPOSE: To evaluate legislative differences in defining the Affordable Care Act's (ACA) pediatric dental benefit and the role of pediatric advocates across states with different health insurance Exchanges. METHODS: Data were collected through public record investigation and confidential health policy expert interviews conducted at the state and federal level. RESULTS: Oral health policy change by the pediatric dental profession requires advocating for the mandatory purchase of coverage through the Exchange, tax subsidy contribution toward pediatric dental benefits, and consistent regulatory insurance standards for financial solvency, network adequacy and provider reimbursement. CONCLUSIONS: The pediatric dental profession is uniquely positioned to lead change in oral health policy amidst health care reform through strengthening state-level formalized networks with organized dentistry and commercial insurance carriers.

The Affordable Care Act and health insurance exchanges: effects on the pediatric dental benefit.

PURPOSE: To examine the relationship between state health insurance Exchange selection and pediatric dental benefit design, regulation and cost. METHODS: Medical and dental plans were analyzed across three types of state health insurance Exchanges: State-based (SB), State-partnered (SP), and Federally-facilitated (FF). Cost-analysis was completed for 10,427 insurance plans, and health policy expert interviews were conducted. One-way ANOVA compared the cost-sharing structure of stand-alone dental plans (SADP). T-test statistics compared differences in average total monthly pediatric premium costs. RESULTS: No causal relationships were identified between Exchange selection and the pediatric dental benefit's design, regulation or cost. Pediatric medical and dental coverage offered through the embedded plan design exhibited comparable average total monthly premium costs to aggregate cost estimates for the separately purchased SADP and traditional medical plan (P=0.11). Plan designs and regulatory policies demonstrated greater correlation between the SP and FF Exchanges, as compared to the SB Exchange. CONCLUSIONS: Parameters defining the pediatric dental benefit are complex and vary across states. Each state Exchange was subject to barriers in improving the quality of the pediatric dental benefit due to a lack of defined, standardized policy parameters and further legislative maturation is required.