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.

Factors associated with moderate sedation attendance at a university-based pediatric dental clinic.

PURPOSE/OBJECTIVES: To evaluate patient attendance for moderate sedation (MS) at a university-based pediatric dental clinic; to identify factors with negative impact on MS being completed and to assess for associations between no-show appointments and patient variables METHODS: The electronic health records of patients scheduled for MS appointments in a 22-month period were assessed by a single investigator. Demographic and clinical data related to appointment attendance and MS procedure performance were collected and statistically analyzed using chi-square, Spearman's rho correlation tests, and logistic regression (p < 0.05) RESULTS: A total of 618 scheduled MS appointments were included. The MS appointment no-show-rate was 17.1 percent. Appointment confirmation (p = 0.001) and dmft score ≥ 9 (p = 0.039) had positive correlation with attendance, while "no-shows" history (p = 0.024) and longer waiting time (p = 0.040) had negative impact on attendance. About 20% of attended MS were not completed, with main reasons of airway risk (32.3%), ongoing illness (28.4%), and violation of NPO guidelines (21.5%). Race, ethnicity, language spoken, child's behavior, and distance traveled had no significant impact on attendance CONCLUSION: Interventions to decrease non-attendance rates should target patients who are unconfirmed, have a history of no-show appointments, and are scheduled well before the sedation appointment.

A qualitative analysis of caregiver perceptions of pediatric dental surgery under general anesthesia.

BACKGROUND: Dental surgery under general anesthesia (GA) is a common treatment for severe childhood caries and thus may serve as an event to motivate behavior change. The frequency of recurrent caries, however, indicates opportunities within current practice to change a child's oral health behaviors. AIM: To assess caregiver experiences related to their child's dental surgery to inform development of a behavioral intervention. DESIGN: Semi-structured interviews with caregivers of children receiving GA for dental surgery. Transcripts (n = 19) were analyzed using qualitative thematic methods. RESULTS: Children were 2-5 years of age, mean 3.8 years. Limited access to GA services was a source of caregiver frustration and a barrier to caries treatment. Surgical events elicited emotional reactions including guilt, anxiety, and a sense of caregiver accountability for development of severe caries. There was variation in caregiver awareness and/or motivation to change oral health behaviors. CONCLUSIONS: A child's dental surgery under GA is an emotionally challenging event yet may inspire hope and expectations for improvement. Surgery offers an opportunity to implement interventions at a time when caregivers may be open to assistance with behavior change, though stress and anxiety may create barriers. Behavioral interventions should be tailored to individual caregiver needs/barriers and stage of developmental readiness.

Female Caregivers' Depression Risk Affects Children's Attendance to Dental Appointments: A Pilot Study.

Purpose: This pilot study aimed to evaluate the association between women's depression risk and their children's return for dental treatment. Methods: A total of 175 female caregivers of children presenting for an initial dental examination between May and October 2019 at a university clinic answered demographic questions and a validated survey on depression risk. An analysis of caregiver's depression risk relative to children's attendance at the next treatment appointment was made. Results: One hundred and eight female caregivers were included in the analysis. Average age was 33 years (standard deviation ± 6.5 years), and 52 percent were Hispanic. The rate of risk for depression was 17.5 percent. Most women at risk lived at least 20 miles away, had an income of less than $29,999, were unemployed or employed part-time, and had no help with childcare. White caregivers were more likely to fail to attend their child's appointment (chi-square [X²] = 7.80, P=0.02) while Hispanic women were more likely to return (X² = 4.10, P=0.04). Caregivers with low depression risk were more likely to return for the child's scheduled appointment (X² = 13.37, P<0.001). Thus, there was a positive association between high depression risk and failed appointments (r=0.474, P<0.01). Conclusion: Children of women at risk for depression are more likely to fail to attend their dental appointment.

Gender Differences in Pediatric Dentistry Chairs in the United States and Canada.

OBJECTIVE: To analyze gender differences in personal and professional demographics, job perceptions and work satisfaction between male and female pediatric dentistry academic leaders in the United States and Canada. STUDY DESIGN: A 40-question survey was sent electronically to department chairs requesting information about demographics, current circumstances of the position, professional history, and opinions about the position. Data was analyzed by the sex of the respondent. RESULTS: Eighty-eight surveys were distributed electronically and 55 chairs responded (response rate: 62.5%). Women comprised 29.5% of the sample, were younger and had less leadership training than men. Men had served longer in the position (t(41)=2.02, p=0.05) and had higher ranking academic titles. Women spent more time managing personnel (p=0.026), creating courses and programs (p=0.029), and teaching (p=0.006) than men. Female chairs perceived to have a difficult relationship with the faculty (p=0.027), felt they received less faculty support (p=0.002), and were significantly more dissatisfied in the job (p=0.037). Men were more stressed about a heavy workload than women (p=0.001). CONCLUSION: Gender was significantly related to the demographics, experience, perceptions of the skills and abilities required for job performance, time management and job satisfaction for pediatric dentistry department chairs in American and Canadian institutions.

Understanding Oral Health Behaviors Among Children Treated for Caries Under General Anesthesia.

Purpose: To identify factors that influence oral health behaviors in the pediatric population treated for caries under general anesthesia (GA).
Methods: Nineteen semi-structured key informant interviews were conducted with caregivers while their children received comprehensive dental care under GA. Interviews were recorded on audio and professionally transcribed. Transcripts were coded using an inductive approach, with codes categorized and themes identified in an iterative process among four investigators.
Results: Data from 14 English and five Spanish interviews were reported. Factors that impacted accessing dental services, toothbrushing, and sugar intake were related to experiences living with severe caries and family dynamics. Many caregivers found the process of accessing care challenging, with barriers ranging from a caregiver's denial of disease severity to insurance status and provider availability. Discordant dynamics between parents and their children hindered efforts to change oral health behaviors. Stress of daily life impacted the ability for some caregivers to prioritize oral health.
Conclusion: Our findings provide a better understanding of how a family's experiences and dynamics prior to dental care under GA can serve as barriers to changing oral health behaviors within an urban, Medicaid-enrolled population. Future work should address the complexity and context of familial interactions in efforts to improve surgical outcomes.

Characteristics and Professional Development Needs of Pediatric Dentistry Chairs in the United States and Canada.

Purpose: To describe the demographics of pediatric dentistry department chairs in the United States and Canada, characterize the skills and abilities required for the job, understand how they spent their time, and identify their professional development needs. Methods: An electronic survey was sent to 88 department chairs about personal demographics, leadership, management and personal qualities important for the job, and professional developmental needs. The data were analyzed using descriptive statistics. Results: The response rate was 62.5 percent. The respondents' mean age was 54.5 years (±8.9 years standard deviation); 68.2 percent of respondents were male, and 57 percent were Caucasian non-Hispanic. Most obtained their dental degree and specialty training in the USA, and 85 percent were board certified. They worked an average of 49.4 hours a week, spending a lot of time dealing with communications, teaching, and administrative materials. More than 80 percent lacked clear job expectations provided to them or they were only reviewed verbally. A minority (10.8 percent) was dissatisfied or very dissatisfied with the job. Conclusions: Most chairs were Caucasian, male, challenged by faculty and administrative issues and received no clear expectations for the job but were satisfied overall. Developing leadership and mentorship skills were important for the job execution.

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.

Where Do Pediatric Dental Residents Intend to Practice? Exploring the Influence of Loan Repayment Programs and Other Factors.

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.

Timing of Case-Based Discussions and Educational Outcomes for Dental Students.

The aim of this study was to determine if the timing of a case-based discussion affected dental students' assessment scores. The study specifically investigated whether the timing of a 60-minute case-based discussion before or after a 90-minute lecture affected students' performance on a quiz on topics in pediatric dentistry. In addition, students' preferences for the timing of the case discussion and confidence in the material with different timings were assessed in a survey. In a crossover design, all 52 second-year students in fall 2016 at one U.S. dental school participated in a case-based discussion either before or after lectures on stainless steel crowns and pulp therapy, compared to a control unit on space maintenance with no case-based discussion. The students took quizzes and responded to questionnaires a week after the lectures. A total of 45 (87%) of the 52 students consented to have their scores used. The results showed that the students performed better on the quiz when participating in a case-based discussion after the lecture compared to the discussion before the lecture (after mean=6.1±0.8 vs. before mean=5.5±1.3). The students' control quiz mean following a lecture with no associated case discussion was 6.3±0.8. Students also expressed more confidence when the case was held after the lecture (12.7 vs. 11.6, p=0.02) and preferred the case after (p=0.01). This study found that higher quiz and confidence scores resulted when a case discussion was held after (vs. before) a lecture. When dental educators consider adding a case discussion to a lecture format as a method of increasing students' active learning, these results suggest that having the case discussion after the lecture may be more effective for learners new to the material.

The Health System and Policy Implications of Changing Epidemiology for Oral Cavity and Oropharyngeal Cancers in the United States From 1995 to 2016.

Oral cavity and oropharyngeal cancers are typically grouped under the general term, "oral cancer." Yet, the incidence of oropharyngeal cancers is increasing in the United States, while the incidence of oral cavity cancers has declined. These 2 distinct but conflated groups of oral cancers are attributed to different risk factors. Incidence and survival trends were examined across US population groups and by anatomical subsite. Disparities in incidence and survival by sex, race/ethnicity, and subsite were identified. Risk factors are complex, interactive, and not fully identified. Cancer control research illustrates health disparities in access to care and patient outcomes. Database and supplemental searches yielded 433 articles published between 1995 and 2016 characterizing aspects of oral cancer epidemiology relating to incidence, survival, risk, disparities, and cancer control. Oral cavity cancer survival in black men remains the most intractable burden. Although understanding of oral cancer etiology is improving, application to policy is limited. Cancer control efforts are diverse, sporadic, limited in scope, and generally lacking in success, and they need stratification by oral cavity cancers/oropharyngeal cancers. Further intervention and epidemiologic research, improved workforce capacity, and integrated care delivery are identified as important directions for public health policy. Sustained, multilevel campaigns modeled on tobacco control success are suggested.

Assessing oral cancer early detection: clarifying dentists' practices.

OBJECTIVE: This study explores new methods for assessing in greater detail what dentists do when they perform oral cancer early detection examinations. It clarifies practice behaviors and opens opportunities to identify factors that facilitate thorough early detection examinations by clinicians and to assess the relative effectiveness of different examination procedures. METHODS: A 38-item survey instrument was e-mailed to dentists in a western US, multistate dental practice group. Questionnaires were received by 241 dentists, and 102 responded. An Oral Cancer Knowledge scale (0 to 14) was generated from correct responses on oral cancer general knowledge. An Oral Cancer Examination Thoroughness scale was calculated from the two dimensions of reported usage and frequency of procedures in oral cancer examinations. RESULTS: Nearly all responding dentists were in general practice (90%), with a median year of graduation from dental school of 1994. The Oral Cancer Knowledge scores ranged from 5 to 14 with a mean of 10.4. The mean Thoroughness of Examination score was 11.34 (range 0 to 20). The two scales were not statistically correlated (r = -0.015, P = 0.883). Statistically, recency of continuing education was significantly associated with knowledge (P = 0.0284) and appears to be marginally associated with thoroughness (P = 0.075). CONCLUSIONS: This study documents considerable variability in dentists' knowledge and thoroughness of examinations. The scales provide tools for future studies for improving understanding of early detection of oral cancer in clinical practice.

Training in the primary prevention and early detection of oral cancer: pilot study of its impact on clinicians' perceptions and intentions.

In this pilot study, we tested a new program for training medical care providers in the primary prevention and early detection of oral cancer. The training program consisted of two modules: (1) oral cancer epidemiology and head and neck examinations for the early detection of oral cancer and (2) assessment and counseling of patients in tobacco cessation. On a pretraining questionnaire, the 8 participating clinicians (3 primary care physicians, 4 ENT nurses, and 1 physician assistant) indicated that they had only a limited awareness of oral cancer, that they generally did not routinely examine asymptomatic patients for oral cancer, and that they engaged in only a limited amount of risk assessment/counseling with their patients. On a post-training questionnaire, they indicated that their training had been well received and would prompt them to increase their efforts to examine their patients for early signs of oral cancer and to counsel them about its risks.

Why implementation processes vary across the 5A's of the Smoking Cessation Guideline: administrators' perspectives.

Unrelated to any research, 18 maternal and child health case management agencies adopted a smoking cessation program that included the ask, advise, assess, assist, and arrange components of the 2000 U.S. Public Health Service Smoking Cessation Guideline. To better understand what influences program implementation in practice, a study was conducted 18 months later at 16 (89%) of the agencies. Open-ended interviews with key administrative informants examined implementation processes (i.e., how each program component had been implemented at the organization level) and the administrators' rationales for such implementation. A separate structured telephone survey of the agency case managers (N = 63) assessed their implementation of each program component with smokers. Results showed that all agencies implemented the ask and advise components. Implementation of these components was well supported by the policies, contractual requirements, and operational tools that guided and coordinated all case management activities. No agency implemented the initially adopted program or any other structured approach to implementing the assess, assist, and arrange components. Administrative explanations indicated that these components (a) were not addressed by, and could not be easily incorporated into, the above existing policies and operational tools and (b) were perceived to be in the realm of case manager responsibilities and professional decisions, not requiring administrative attention. Several administrators also cited time constraints, other pressing case management issues, or lack of resources as additional barriers. Based on the findings, recommendations for systemic program support strategies are offered that could improve case management implementation of smoking cessation interventions beyond basic advice to quit.

Oral cancer prevention and early detection knowledge and practices of Illinois dentists--a brief communication.

OBJECTIVES: The purpose of the study was to assess Illinois dentists' self-reported knowledge and practices concerning oral cancer prevention, early detection, and management as a baseline prior to conducting interventions designed to increase dentists' capacity to detect and manage oral cancers and counsel their patients about risk reduction. METHODS: A weighted sample to represent licensed dentists in 19 counties yielded 518 dentists who responded to a 38-item mailed survey in 2004. RESULTS: Over 92 percent of the dentists reported providing oral cancer exams. However, many are not doing them properly or at frequent intervals. Over two-thirds had oral cancer continuing education, but 40 percent had it more than 2 years prior to the survey. Training in risk counseling was rare. CONCLUSIONS: Interventions are needed to assure appropriate skill and knowledge levels for oral cancer early detection, management, and risk counseling by Illinois dentists.