Women's HIV disclosure to the dentist: Does frequent contact matter?

OBJECTIVES: Research has shown inconsistent patterns of patients' HIV serostatus disclosure to their dentists. Common barriers to disclosure have included confidentiality concerns, fear of treatment refusal, and discrimination. This study evaluated the prevalence of HIV serostatus disclosure to the dentist, whether the frequency of dental care utilization is associated with disclosure, and reasons for nondisclosure among women living with HIV. METHODS: We administered a cross-sectional oral health survey to 1,526 women living with HIV in the Women's Interagency HIV Study including questions regarding HIV serostatus disclosure to dentists. Logistic regression models were used to analyze the association between dental care utilization (at least annually versus less than annually) and HIV serostatus disclosure to dentists. RESULTS: Overall, 83 percent of women reported that they disclosed their HIV serostatus to their dentist. The most common reasons for nondisclosure were: a) the dentist did not ask, b) believing that the dentist did not need to know, and c) not having a consistent dentist. In the multivariable logistic regression model, at least annual dental care utilization, compared to less than annual, led to a 59 percent reduction in the odds of HIV nondisclosure to the dentist. DISCUSSION: Study findings highlight that dentists who see their patients infrequently should consider methods for overcoming barriers to HIV nondisclosure and the possibility that their patient's HIV serostatus is undisclosed. Educating women living with HIV about how disclosure to dentists is a critical component of their dental assessment and treatment, and how preventive dental treatment can improve overall health outcomes, is important.

Oral health-related quality of life and unmet dental needs among women living with HIV.

BACKGROUND: Oral health-related quality of life (OHRQoL) is a multidimensional, perception-based measure of how oral health affects social and physical functioning and self-image. OHRQoL is important for assessing women living with HIV (WLWH) who may have unmet dental needs and experience disparities that impact dental care accessibility. METHODS: In 2016, the authors conducted an assessment of OHRQoL among a national sample of 1,526 WLWH in the Women's Interagency HIV Study using the Oral Health Impact Profile instrument, which assesses the frequency of 14 oral health impact items. OHRQoL was measured using multivariable linear regression with a negative binomial distribution to assess the association between report of a recent unmet dental need and OHRQoL. RESULTS: "Fair or poor" oral health condition was reported by 37.8% (n = 576) of WLWH. Multivariable linear regression showed that unmet dental needs had the strongest positive association with poor OHRQoL (difference in Oral Health Impact Profile mean, 2.675; P < .001) compared with not having unmet needs. The frequency of dental care utilization was not associated with higher OHRQoL. Older age, fair or poor dental condition, smoking, symptoms of anxiety and loneliness, and poor OHRQoL were also associated with worse OHRQoL. CONCLUSION: Self-perceived impact of oral health on social and physical function and self-image, as measured by OHRQoL, may be an easily assessable but underrecognized aspect of OHRQoL, particularly among women aging with HIV. PRACTICAL IMPLICATIONS: Dentists should implement OHRQoL assessments in their management of the care of patients with HIV to identify those who do have significant oral health impacts.

Dental insurance, dental care utilization, and perceived unmet dental needs in women living with HIV: Results from the Women's Interagency HIV Study.

OBJECTIVES: Dental care is the most commonly cited unmet health-care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority. METHODS: Oral health surveys were collected cross-sectionally (April-October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months. RESULTS: All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self-reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29-6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34-0.57]). Self-reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46-3.01]). CONCLUSIONS: Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health-care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.

Factors associated with early childhood caries incidence among high caries-risk children.

OBJECTIVES: To assess the relationships between different behavioral factors and Early Childhood Caries (ECC) in African-American pre-school children. METHODS: Ninety-six African-American children aged 3-22 months old at baseline were recruited from a high caries risk, non-fluoridated African-American community in Uniontown, Alabama. The children had dental examinations annually following World Health Organization (WHO) criteria at mean ages 1.1, 2.0, 3.1 and 4.0 years. All children received fluoride varnish application at each study visit. Parents provided oral hygiene and dietary information semiannually by completing questionnaires. Area-under-the-curve (AUC) with the trapezoidal rule was used to summarize longitudinal exposure data. Bivariate and multivariable relationships between ECC incidence and behavioral risk factors were assessed using logistic regression and negative binomial modeling for dichotomous and count dependent variables, respectively, with the independent variables defined at age 1, age 3 and as the AUC. RESULTS: Greater frequency of toothbrushing and greater AUC composite of daily frequency of consumption of 100% juices were associated with lower incidence of dental caries (P-values = 0.01 and 0.049, ORs = 0.34 and 0.37, respectively). Greater AUC of daily frequency of consumption of sweetened foods and history of a previous visit to a dentist by age 3 were associated with greater incidence of ECC (ORs = 9.22 and 4.57, P-values = 0.002 and 0.03, respectively). CONCLUSION: For these children living in a non-fluoridated community, more frequent consumption of sweetened food, less frequent consumption of 100% juice, less frequent toothbrushing, and reporting a previous visit to a dentist were significantly associated with greater ECC incidence.

Prevalence and incidence of early childhood caries among African-American children in Alabama.

OBJECTIVES: This study aims to assess the prevalence and incidence of early childhood caries (ECC) in African-American children. METHODS: A cohort of 96 African-American children approximately 1 year of age at baseline were recruited in Uniontown, Alabama, and followed for 3 years. Oral examinations were conducted annually by one of three trained/calibrated dentists using portable equipment, without radiographs, following WHO criteria. RESULTS: The prevalence of decayed/missing/filled surfaces (dmfs) was: 1.1 percent (all d) at approximately age 1 (n = 90, six children were excluded for having no erupted teeth); 12.8 percent (d = 10.5 percent & f = 4.7 percent) at age 2 (n = 86); 39.3 percent (d = 21.4 percent, m = 2.4 percent & f = 22.6 percent) at age 3 (n = 84); and 65.8 percent (d = 28.8 percent, m = 5.5 & f = 46.6 percent) at age 4 (n = 73). The percentages of incisors, canines, first molars, and second molars with dmfs were: 0.1 percent, 0.0 percent, 0.0 percent, and 0.0 percent, at age 1; 2.4 percent, 0.1 percent, 0.8 percent, and 0.6 percent at age 2; 8.2 percent, 0.8 percent, 7.6 percent, and 6.3 percent at age 3; and 10.2 percent, 2.2 percent, 12.6 percent and 16.7 percent at age 4, respectively. The three, 1-year, person-level incidence rates were 12.8 percent (age 1 to age 2), 38.6 percent (age 2 to age 3), and 56.2 percent (age 3 to age 4). From baseline, the 2-year incidence was 39.3 percent and 3-year incidence was 65.8 percent, whereas the 2-year caries incidence from age 1 to age 3 was 66.7 percent (n = 72). CONCLUSION: The majority of children developed caries during the 3-year follow-up, which is much higher than the 32 percent prevalence of caries among African-American children under age 6 years in National Health and Nutrition Examination Survey from 1999 to 2002.