Kansas Extended Care Permit III Providers: A descriptive study.

Purpose Forty-two states to date have passed legislation to expanded the role of dental hygienists for improved access to basic oral health services for underserved populations. Recent legislative changes in the state of Kansas have created the Extended Care Permit (ECP) I, II, and III designations. The purpose of this study was to examine the experiences of registered dental hygienists in Kansas holding ECP III certificates.Methods Secondary data analysis was performed utilizing data collected from an ECP provider survey conducted in 2021. Dental hygienists in Kansas holding an Extended Care Permit III (n=88) were sent a 39-item electronic survey and informed consent was obtained prior to beginning the survey. Descriptive data analyses consisted of frequency distributions and percentages. Inferential data analysis consisted of Fisher's Exact and Chi-Square tests to evaluate associations between ECP III demographics, practice characteristics, and services provided.Results A total of 22 responses were received for a 25% response rate. The majority of the respondents (77%) were employed by a Safety Net Clinic. The practice settings reporting the highest percentage of ECP III services during the period of data collection were school-based settings, using portable equipment (68%). No associations were found between ECP III personal and practice characteristics and the provision of services specific to the ECP III permit.Conclusion Results suggest that a low percentage of ECP III permit holders are providing ECP III-specific services. Considering these findings and the outcomes of previous studies, there is speculation that barriers continue to exist that prevent permit holders from performing ECP III-specific services and providing dental hygiene services to the fullest extent of an ECP license.

Dental Hygiene and Direct Access to Care: Past and present.

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist, and maintain a provider-patient relationship. In 2000 there were nine direct access states; currently there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships which have influenced and advocated for direct access and the recognition of dental hygienists as primary health care providers. The National Governors Association (NGA) released a report in 2014 suggesting that dental hygienists be "deployed" outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies, and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential health care providers, prepared to deliver direct access to dental hygiene care.

Dental hygiene and direct access to care: Past and present.

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider-patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be 'deployed' outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.

Associations of Self-Reported Oral Health Quality of Life with Actual Oral Health Status in Children.

Purpose: Quality of life is considered a component of patient centered care. The purpose of this study was to examine the relationship between self-reported oral health related quality of life (OHRQoL) and the actual oral health status of children.Methods: This retrospective cohort study consisted of pediatric dental chart reviews from three clinics. Demographic and dental visit data along with the child's OHRQoL utilizing the Pediatric Oral health-related Quality of Life (POQL) instrument, were collected. Associations with untreated decay, treated decay, or POQL score were tested, using Chi-square, Fisher's exact test, 2-sample t-tests, or ANOVA. Linear regression was used to evaluate the effect of statistical confounders in the relationship between untreated decay and POQL scores. Significance level was set to 0.05.Results: Two hundred ninety-seven out of 336 children had both POQL and caries data. White children and children with untreated decay had significantly more negative POQL scores. Children rating their oral health as "excellent" or "very good" and children with sealants on molars had significantly more positive POQLs. Associations between POQL scores were significant with untreated decay, but not sealants, when considering both variables in the same model. After adjusting for having sealants, POQL scores were on average 7.5 points higher (more negative) in children with untreated decay, than in children without decay (p<0.001).Conclusions: Collecting OHRQoL data allows oral health providers to easily incorporate patient perceptions in their assessment and care and would ensure that all oral health needs of the patients are being met. This is important for children, who may have difficulty expressing their concerns, particularly in clinical environments.

Evaluation of a pipeline program at strengthening applications, increasing diversity, and increasing access to care.

PURPOSE: To evaluate the outcomes of a dental pipeline program at strengthening dental school applications, growing the diversity of dental students, and increasing access to care METHODS: This program evaluation used a descriptive and quasi-experimental retrospective study design. Researchers analyzed secondary data, from a dental pipeline program, for the years 2011-2018. Descriptive statistics were used to describe short-term and intermediate outcomes and impact. Associations were tested using paired t-test, 2-sample t-test, analysis of variance, and chi-squared test RESULTS: Ninety-eight scholars completed the 10-week program. The majority of scholars were female (70%), non-Hispanic or Latino (76%), non-White (72%), and pursuing baccalaureate degrees (94%). After completing the program, the mean Dental Admission Test (DAT) Academic Average Score (AAS) increased (16.0 vs. 17.5, P < 0.01). Significant associations were revealed between post-program DAT AAS and being accepted into dental school (P = 0.02). Associations remained when stratified by gender (male P = 0.01) and ethnicity (P = 0.03). The majority of scholars (71%) applied to the host school. Over half of the scholars matriculated to dental school (55%). Twenty-nine scholars (30%) graduated from the host school. Graduates report choosing careers in private practice (38%), public health (24%), corporate dentistry (17%), and the military (3%) CONCLUSION: Dental pipeline programs are effective at strengthening dental school applications, increasing DAT AAS, growing the diversity of dental students, and increasing access to care. Dental education needs to examine barriers dental pipeline programs do not typically address, such as the high cost of applying to dental school, and identify additional ways to support underrepresented minority students entering into dentistry.

Workforce Policies and their Influence on School-Based Oral Health Programs: A synthesis of four case studies.

Purpose: Childhood caries disproportionately effects children who are poor, live in low-income rural and urban areas, and come from racial and ethnic minority groups. The purpose of this study was to explore the effect of public policy related to dental hygienists' level of supervision and policy uptake at the state level on the organization, delivery, and financing of school-based oral health programs (SBOHP).Methods: A multiple case study methodology was used to compare SBOHPs in the states of Missouri and Kansas. Interviews were conducted with an administrator, dental hygienist, and dentist at each Federally Qualified Health Center (FQHC) that operated a SBOHP. Mixed methods were used to conduct and analyze interviews, examine supporting documents, and to report descriptive details. Analytic categories were used to examine the various facets of the organizational structures, delivery processes, financing and billing, and operations.Results: Five themes revealing differences between two states emerged; historical development of SBOHPs, the structure of SBOHPs, staffing and professional relationships, finance and billing, and capacity of school-based oral health network.Conclusion: Dental hygienists' supervision requirements play a critical role in school-aged children's access to oral health services and the capacity of SBOHPs. The variations in the degree of practice autonomy accorded to dental hygienists under the Missouri and Kansas dental practice acts resulted in different oral health delivery models. Greater autonomy for dental hygienists is essential for realizing the promise of dental public health.

Experiences of the Kansas Extended Care Permit Providers: A descriptive study.

Purpose: A total of 40 states to date have expanded the role of dental hygienists with the goal of improving access to basic oral health services for underserved populations. In Kansas, legislative changes have resulted in the Extended Care Permit (ECP) designation. The purpose of this study is to describe the experiences of registered dental hygienists in Kansas holding ECP certificates (ECP RDH) as of July of 2014.Methods: Secondary data analysis was performed utilizing data collected from a survey conducted in 2014 by Oral Health Kansas. All registered ECP RDH's were sent the 32-item survey via Survey Monkey®. Descriptive statistical analyses consisted of frequency distributions, and measures of central tendency. Inferential analyses using t-tests and ANOVA were conducted to compare groups.Results: A total of 73 responses were received from the (n= 176) surveys that were e-mailed for a 41% response rate. Of the clinicians who responded, 80%, worked at least part-time and in school settings. The most consistent barriers to providing care were the inability to directly bill insurance (52%), financial sustainability (42%) and physical requirements (42%). Follow-up tests found significant differencs between clinician groups when examining barriers.Conclusion: Although the ECP legislation appears to be expanding access to care for citizens in Kansas, significant barriers still exist in making this a viable model for oral healthcare delivery.

Extending oral health care services to underserved children through a school-based collaboration: Part 3--A cost analysis.

PURPOSE: The purpose of this manuscript was to conduct a cost analysis of the Miles of Smiles Program, a collaboration between the University of Missouri-Kansas City School of Dentistry and the Olathe School District in Kansas. This preventive program was implemented to improve the access to oral health care for low income children within the school district. METHODS: An inventory list and de-identified patient records were used to determine the costs associated with operating the program to serve 339 elementary school students during the 2008 to 2009 school term. Costs related to equipment, supplies and personnel were included. The costs were then compared to the amount of Medicaid reimbursement obtained for the services provided. Additionally, the cost of operating a similar program, if staffed by dental professionals rather than supervised dental hygiene students, was estimated. RESULTS: The cost of operating the program during the 2008 to 2009 school term was $107,515.74. The program received Medicaid reimbursement for approximately 1.5% of the total operating cost of and approximately 6.3% of the total billable services, however, challenges with submitting and billing Medicaid claims for the first time contributed to this low rate of reimbursement. If a similar program that utilized dental professionals was implemented and treated the same number of patients, the cost would be approximately $37,529.65 more due to higher expenses associated with personnel and supplies. CONCLUSION: The program is not self-sustainable based on Medicaid government-funded insurance reimbursement alone, and therefore continuous external sources of funding or a change in the program design would be necessary for long-term sustainability of the program.

Extending oral health care services to underserved children through a school-based collaboration: Part 3--a cost analysis.

PURPOSE: The purpose of this manuscript was to conduct a cost analysis of the Miles of Smiles Program, a collaboration between the University of Missouri-Kansas City School of Dentistry and the Olathe School District in Kansas. This preventive program was implemented to improve the access to oral health care for low income children within the school district. METHODS: An inventory list and de-identified patient records were used to determine the costs associated with operating the program to serve 339 elementary school students during the 2008 to 2009 school term. Costs related to equipment, supplies and personnel were included. The costs were then compared to the amount of Medicaid reimbursement obtained for the services provided. Additionally, the cost of operating a similar program, if staffed by dental professionals rather than supervised dental hygiene students, was estimated. RESULTS: The cost of operating the program during the 2008 to 2009 school term was $107,515.74. The program received Medicaid reimbursement for approximately 1.5% of the total operating cost of and approximately 6.3% of the total billable services, however, challenges with submitting and billing Medicaid claims for the first time contributed to this low rate of reimbursement. If a similar program that utilized dental professionals was implemented and treated the same number of patients, the cost would be approximately $37,529.65 more due to higher expenses associated with personnel and supplies. CONCLUSION: The program is not self-sustainable based on Medicaid government-funded insurance reimbursement alone, and therefore continuous external sources of funding or a change in the program design would be necessary for long-term sustainability of the program.