Access to restorative oral health care for children living in Illinois with Medicaid vs private dental insurance: An audit study.

BACKGROUND: Public dental insurance programs for children aim to provide access to care, but barriers remain that preclude care delivery. Understanding these barriers is an important health policy concern. METHODS: A telephone audit sought to ascertain availability of oral health care for children in dental offices eligible to bill Medicaid. Female callers posing as mothers called eligible offices requesting appointments. In this cross-over design, offices were randomized to public or private insurance for initial calls and then to the other condition after a washout period. RESULTS: Using mixed models, privately insured patients had 5.9 times (95% CI, 4.55 to 7.69) greater odds of obtaining an appointment than Medicaid patients. Compared with patients in Cook County, suburban patients had slightly better odds, whereas nonurban patients in larger and smaller rural counties had lower odds of success. CONCLUSIONS: Medicaid compares poorly with private insurance for providing access to pediatric oral health care. Regardless of insurance conditions, access is poor in less urban environments compared with metropolitan communities. PRACTICAL IMPLICATIONS: Even Medicaid-enrolled dental practices limit the care they extend to insured children. Providing Medicaid by itself cannot overcome large oral health care access disparities, which are greatest in rural communities.

Exploring dental faculty perceptions of current strategies and barriers to retention.

PURPOSE: The aims of the study were to identify perceived strategies for and barriers to faculty retention and examine differences regarding age, gender, and race. METHODS: Cross-sectional data was captured from the eight author-affiliated dental schools. A Qualtrics survey was emailed to all faculty members at these institutions (1467 possible participants) between November 2021 and February 2022. The survey was formulated from best practices listed in the American Dental Education Association Faculty Diversity Toolkit. It consisted of 18 questions, including demographic information and faculty perceptions of their respective workplaces. These responses were then evaluated with descriptive statistics, Chi-squared analysis, Pearson Correlation, and Fleiss' kappa. RESULTS: The survey's response rate was 19.2%. There was no significant difference in perceived retention strategies across race, age, gender, practice tenure, practice type, or clinical versus tenure track. The top four barriers identified were inadequate financial compensation, workload, poor work environment, and burnout. There was a significant difference between racial groups and their perceived barrier of support for promotion (p = 0.048). This was more prevalent among clinical faculty (47.7%) than tenure track faculty (16.2%). The work environment was listed as a leading factor for both promoting retention and encouraging the exodus of faculty members. CONCLUSION: Strategies aimed at improving financial compensation, career recognition, and transparency of the promotion process, along with those aimed at improving the work environment were shown to be vital to retaining faculty. Though the low response rate is a study limitation, these findings provide valuable information and a framework for future studies regarding dental faculty recruitment and retention.

Adolescents' Awareness of E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) and E-Cigarette Use Impact on Health.

PURPOSE: The purposes of this study were to: (1) examine adolescents' knowledge regarding e-cigarettes and e-cigarette or vaping product use-associated lung injury (EVALI), and (2) describe common misconceptions regarding e-cigarette use. METHODS: Adolescents aged 13 to 19 years were recruited in pediatric dental clinics and completed a survey questionnaire regarding their knowledge of e-cigarettes. RESULTS: A total of 66 adolescents participated. Forty-seven adolescents indicated knowledge of e-cigarettes. Forty adolescents recognized that most e-cigarettes contain nicotine, and 49 adolescents reported knowledge of EVALI cases. Adolescents had knowledge of possible lung damage from e-cigarette use. Adolescents also had misconceptions about e-cigarettes containing nicotine and them being less addictive than other tobacco products. CONCLUSIONS: Adolescents were aware of e-cigarette or vaping product use-associated lung injury cases, and the majority of them viewed e-cigarette use as harmful to their health. However, some adolescents had misconceptions regarding the safety of e-cigarette use. Oral health providers should recognize that they play an important role in identifying risky behaviors amongst adolescents, incorporate adolescent-specific risk assessments into their clinical practice, and be comfortable providing anticipatory guidance about e-cigarette and nicotine use.

Prevalence of Radiographically Identifiable Dental Anomalies in Children and Association with Health Status.

Purpose: The purpose of this study was to describe the prevalence of radiographically identifiable developmental dental anomalies (DDA) in a university-based pediatric dental clinic and to assess for associations between DDA and health status. Methods: Retrospective data, obtained from the electronic dental records of a three-year pediatric patient cohort, were evaluated by two trained and calibrated examiners. Strict inclusion/ exclusion criteria were applied. A validated image quality grading system was used for radiograph assessment, and the physical status classification of the American Academy of Anesthesiology was utilized. A chi-square test and bivariate logistic regression were used for statistical analysis. The inter- and intraexaminer reliability was assessed using Cohen's Kappa. Results: A total of 1,478 subjects (69 percent medically healthy) were enrolled. DDA were identified in 25 percent of the subjects, with hyperdontia, hypodontia, and microdontia being more common. A statistically significant association was found between the presence of DDA and health status (P<0.001) and between DDA and asthma (P=0.035). Patients with systemic disturbances showed 2.12 times greater odds of having DDA (P<0.001, 95 percent confidence interval equals 1.7-2.7). Conclusions: The prevalence of developmental dental anomalies was high, with one in four patients affected. DDA in number were the most common. Patients with systemic disturbances had greater odds of having DDA.

Nitrous Oxide for Dental Procedures in Pediatric Patients with Sickle Cell Disease: A Pilot Study.

Purpose: The purpose of this pilot study was to evaluate the safety of nitrous oxide (N2O) during dental procedures in pediatric patients with sickle cell disease (SCD). Methods: Patients three to 15 years of age received N2O with oxygen (N2O:O2) during their dental procedure in a university pediatric dental clinic between March 2019 and December 2020. Blood oxygen levels were monitored via pulse oximetry throughout the visit. Caregivers received a follow-up call to assess for postoperative complications. Results: Twenty-three patients were enrolled. The duration of N2O sedation was 20 to 50 minutes. Oxygenation levels during (P<0.001) and after (P=0.004) the procedure were higher than for baseline. No adverse effects were reported in the three days after N2O use. Conclusions: Following dental guidelines for sedation, treatment with up to a 50:50 mixture of nitrous oxide with oxygen increased blood oxygen levels and did not cause postoperative complications in children with sickle cell disease. This is the first formal study confirming the safety of nitrous oxide use in the dental care of SCD patients.

Oral Health Implications of Risky Behaviors in Adolescence.

Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.

Structural Racism and Oral Health Inequities of Black vs. non-Hispanic White Adults in the U.S.

Structural racism negatively affects the health of Black populations in the U.S. Black populations experience a higher burden of oral diseases, such as tooth decay, periodontal disease, and oral and pharyngeal cancers than other racial groups experience. Oral health literature refers to racial inequities in the context of social disadvantage. However, structural racism perpetuates those contributory social disadvantages, such as inadequate access to affordable housing, education, and employment. In addition, in states where nearly 50% of U.S. Black populations reside, there is an inequitable distribution of adult Medicaid dental benefits as well as an inequitable availability of both Black and non-Black oral health care providers. Addressing structural racism in oral health should involve commitment among stakeholders to establish awareness and equity through community-building, policy, oral health workforce development, and research.

Evaluating the association between food insecurity and dental caries in US children 1-19 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014.

OBJECTIVES: To evaluate the association between food insecurity and dental caries in US children aged 1-19 years. METHODS: Data from children ages 1-19 collected through the 2013/2014 National Health and Nutrition Examination Survey was analyzed. Descriptive analysis of both the exposure (food insecurity) and outcome variables (dental caries), as well as covariates, was carried out. Strata-specific odds ratios and respective 95 percent confidence intervals for each covariate were determined, followed by linear regression models. RESULTS: The odd of having dental caries was 2.9 times higher for children who had very low food security. The odds of having dental caries was 2.6 times higher for children aged 6-11, 2.9 times higher for children aged 12-15, and 4.2 times higher for children aged 16-19 when compared to children aged 1-5. CONCLUSIONS: There is a significant association between food insecurity and dental caries in children and dental caries prevalence increases with age.

Effect of Caregiver's Race and Ethnicity on Acceptance of Passive Immobilization for Their Child's Dental Treatment.

Purpose: To determine if caregivers' race and ethnicity impact their willingness to accept passive immobilization for their child's dental treatment and to determine if a detailed description of passive immobilization will make caregivers more likely to accept the technique.
Methods: Caregivers of one- to 11-year-old patients were recruited in a university pediatric dental clinic. They completed two surveys and reviewed a written and pictorial description of passive immobilization.
Results: A total of 266 caregivers participated. Subjects were willing to accept passive immobilization at the following percentages by race/ethnicity: Hispanic (84 percent); African American (66 percent); Asian (50 percent); and non-Hispanic Caucasian (24 percent). There was a significant association between a caregiver's race and ethnicity and the willingness to consent to passive immobilization (P =.000), and in willingness to accept passive immobilization after reviewing its detailed description (P =.000).
Conclusion: Differences in acceptance of passive immobilization were observed based upon race and ethnicity. African American and Hispanic caregivers were more willing to accept the technique than their Asian and non-Hispanic Caucasian counter- parts. Caregivers were more likely to accept the use of passive immobilization after they were given more information about the technique. (J Dent Child 2019;86(1):3-9) Received May 30, 2018; Last Revision August 3, 2018; Accepted August 7, 2018.