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1.
J Dent Hyg ; 97(6): 5-14, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38061810

ABSTRACT

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.


Subject(s)
Dental Hygienists , Health Services Accessibility , Humans , Kansas , Medically Underserved Area , Surveys and Questionnaires
2.
J Dent Hyg ; 97(5): 24-34, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37816618

ABSTRACT

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.


Subject(s)
Dental Hygienists , Oral Hygiene , Humans , Dental Hygienists/education , Oral Health , Curriculum , Health Services Accessibility , Dental Care
3.
Int J Dent Hyg ; 21(4): 781-788, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37804220

ABSTRACT

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.


Subject(s)
Oral Health , Oral Hygiene , Humans , Curriculum , Dental Hygienists/education , Health Services Accessibility , Dental Care
4.
J Am Coll Health ; : 1-11, 2022 Apr 05.
Article in English | MEDLINE | ID: mdl-35380931

ABSTRACT

OBJECTIVE: To identify the prevalence of anxiety, depression, and suicidal ideation that would place university students at risk for mental health disorders. To explore the source of stressors and possible interventions that may benefit student mental health in a university setting. PARTICIPANTS: University students (n = 483) who had been learning remotely due to the COVID-19 pandemic. METHODS: A mixed-methods cross-sectional survey was administered in 2020. RESULTS: Students were at an increased rate of depression, anxiety and suicidal ideation as compared to the general population. Female gender, lack of social support, living alone, being a first-generation college student and COVID-19 were significantly associated with mental health disorders. Stressors were identified and categorized into themes and interventions were recognized that may improve student well-being. CONCLUSION: Students enrolled in university programs appear to experience significant amounts of anxiety, depression, and suicidal ideation. Additional mental health education, resources, and support is needed.

5.
J Dent Hyg ; 95(1): 57-66, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33627454

ABSTRACT

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.


Subject(s)
Dental Caries , Quality of Life , Child , Dental Caries/epidemiology , Humans , Oral Health , Retrospective Studies , Self Report
6.
J Dent Educ ; 85(5): 642-651, 2021 May.
Article in English | MEDLINE | ID: mdl-33332594

ABSTRACT

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.


Subject(s)
Hispanic or Latino , Minority Groups , Cultural Diversity , Female , Health Services Accessibility , Humans , Male , Program Evaluation , Retrospective Studies , Students
7.
J Dent Hyg ; 93(3): 6-14, 2019 Jun.
Article in English | MEDLINE | ID: mdl-31182563

ABSTRACT

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.


Subject(s)
Oral Health , Workforce , Child , Dental Hygienists , Ethnicity , Humans , Kansas , Minority Groups , Missouri
8.
Public Health Nurs ; 35(4): 259-260, 2018 07.
Article in English | MEDLINE | ID: mdl-29998479
9.
Int Dent J ; 68(6): 433-440, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29786140

ABSTRACT

AIMS: THE OBJECTIVE WAS TO INVESTIGATE IF GENDER DIFFERENCES EXIST IN THE ASSOCIATIONS BETWEEN PERIODONTITIS AND TYPE 2 DIABETES. DISPROPORTIONATE DISPARITIES BY GENDER WERE FOUND TO EXIST IN RATES OF BOTH PERIODONTITIS AND DIABETES WITH RESPECT TO DEMOGRAPHICS AND BEHAVIOURAL PREDICTORS THAT CANNOT BE EXPLAINED SOLELY BY THE WELL-ESTABLISHED ASSOCIATION BETWEEN THESE TWO DISEASES. MATERIALS AND METHODS: MULTIPLE DATASETS WERE EXTRACTED FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2009-2014, WHICH USED A STRATIFIED MULTISTAGE PROBABILITY SAMPLING TO OBTAIN SAMPLES FROM ALL CIVILIAN NON-INSTITUTIONALISED PEOPLE IN THE USA. BIVARIATE RELATIONSHIPS BETWEEN EACH EXPLANATORY VARIABLE AND PERIODONTITIS LEVEL WERE ASSESSED WITH ODDS RATIOS (OR) AND THEIR 95% CONFIDENCE INTERVALS (CI). A SET OF WEIGHTED LOGISTIC REGRESSION MODELS WAS USED TO INVESTIGATE THE ASSOCIATION DIFFERENTIATIONS BETWEEN PERIODONTITIS AND DIABETES BY GENDER. C-STATISTICS MEASURED THE GOODNESS-OF-FIT OF WEIGHTED LOGISTIC REGRESSION MODELS. RESULTS: THE PREVALENCE OF MODERATE-SEVERE PERIODONTITIS WAS 36.39% AND 22.71% AMONG PARTICIPANTS WITH TYPE 2 DIABETES AND WITHOUT DIABETES, RESPECTIVELY. TYPE 2 DIABETES WAS SIGNIFICANTLY ASSOCIATED WITH MODERATE-SEVERE PERIODONTITIS OR (OR = 1.47, 95% CI: 1.18-1.82) AMONG MALES EVEN AFTER ADJUSTING FOR DEMOGRAPHICS, SOCIOECONOMIC STATUS AND ORAL HEALTH BEHAVIOURS. THE AFOREMENTIONED RELATIONSHIP WAS NOT FOUND IN FEMALES. FURTHERMORE, DIFFERENT RELATIONSHIPS OF MODERATE-SEVERE PERIODONTITIS WITH BODY MASS INDEX AND THE USE OF MOUTHWASH WERE FOUND BETWEEN THE MALES AND FEMALES. CONCLUSIONS: THE CURRENT FINDINGS SUGGEST THAT IMPORTANT IMPROVEMENTS IN THE DEVELOPMENT OF GENDER-SPECIFIC STRATEGIES IN PREVENTION, SUCH AS ORAL HOME-CARE, TO REDUCE THE HIGH PREVALENCE OF PERIODONTAL DISEASE AND MAINTAIN GOOD ORAL HEALTH ARE VITAL, AND ARE ESPECIALLY IMPORTANT FOR MALE DIABETIC PATIENTS AND THOSE WHO ARE AT HIGH RISK OF DEVELOPING DIABETES, SUCH AS THOSE WHO ARE OBESE.


Subject(s)
Diabetes Mellitus, Type 2/complications , Periodontitis/complications , Adult , Age Factors , Female , Humans , Male , Middle Aged , Obesity/complications , Periodontitis/epidemiology , Prevalence , Sex Factors , Socioeconomic Factors , United States/epidemiology
10.
J Dent Hyg ; 91(4): 12-20, 2017 Aug.
Article in English | MEDLINE | ID: mdl-29118079

ABSTRACT

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.


Subject(s)
Dental Care/legislation & jurisprudence , Dental Hygienists/legislation & jurisprudence , Dental Hygienists/psychology , Health Services Accessibility , Long-Term Care/legislation & jurisprudence , Attitude of Health Personnel , Delegation, Professional/legislation & jurisprudence , Dental Health Services , Eligibility Determination , Employment , Financial Support , Health Care Surveys , Humans , Insurance, Dental , Kansas , Oral Health , Practice Patterns, Dentists' , Problem Solving , Professional Practice/legislation & jurisprudence , School Dentistry , Workplace
11.
Am J Public Health ; 107(S1): S56-S60, 2017 05.
Article in English | MEDLINE | ID: mdl-28661808

ABSTRACT

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.


Subject(s)
Dental Care for Children/legislation & jurisprudence , Dental Hygienists/legislation & jurisprudence , Public Health Dentistry/organization & administration , School Dentistry , Child , Delegation, Professional/legislation & jurisprudence , Dental Care for Children/economics , Dental Hygienists/supply & distribution , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Humans , Medically Underserved Area , Minority Groups , Oral Health , Poverty , United States
12.
J Sch Nurs ; 33(3): 181-188, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27698209

ABSTRACT

This program evaluation examines the effectiveness of a school-based dental clinic. A repeated-measures design was used to longitudinally examine secondary data from participants ( N = 293). Encounter intensity was developed to normalize data. Multivariate analysis of variance and Kruskal-Wallis test were used to investigate the effect of encounter intensity on the change in decay, restorations, and treatment urgency. A Pearson's correlation was used to measure the strengths of association. Encounter intensity had a statistically significant effect on change in decay ( p = .005), restorations ( p = .000), and treatment urgency ( p = .001). As encounter intensity increased, there was a significant association with the decrease in decay (-.167), increase in restorations (.221), and reduction in referral urgency (-.188). Incorporating dental care into a school-based health center resulted in improved oral health in underserved children while overcoming barriers that typically restrict access. The collaboration of school nurses with the school-based dental clinic was an important element for maximizing student access to dental care.


Subject(s)
Dental Care/methods , Dental Clinics/methods , Oral Health , Program Evaluation/methods , School Health Services , Adolescent , Child , Child, Preschool , Female , Health Services Accessibility , Humans , Kansas , Longitudinal Studies , Male , School Nursing/methods
13.
Am J Public Health ; 105(9): 1763-9, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26180957

ABSTRACT

OBJECTIVES: We evaluated the effect of an alternative dental workforce program-Kansas's Extended Care Permit (ECP) program--as a function of changes in oral health. METHODS: We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations. RESULTS: The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15). CONCLUSIONS: Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services.


Subject(s)
Dental Care for Children/organization & administration , Poverty , Preventive Dentistry/organization & administration , School Dentistry/organization & administration , Child , Dental Hygienists , Electronic Health Records , Female , Humans , Kansas , Male , Models, Organizational , Oral Health
14.
J Dent Hyg ; 88(6): 353-63, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25534688

ABSTRACT

PURPOSE: Frail elders and nursing home residents are vulnerable to poor oral health and frequently lack access to dental care. The purpose of this study was to determine why residents in Arkansas skilled nursing facilities have limited access to oral health care. METHODS: This study utilized qualitative research methodology. Data was collected from oral health care personnel through open-ended responses in a written survey (n=23) and through telephone interviews (n=21). The investigators applied the constant comparative method to analyze and unitize the data and ultimately reach consensus. RESULTS: Data analysis resulted in consensus on 2 emergent themes: policy and access. CONCLUSION: This qualitative case study suggests access to oral health care for residents living in both long-term care (LTC) and assisted living I and II facilities in Arkansas is affected by public and facility policies and access to oral health care as a function of the patient's health status and availability of oral health care providers. Access for residents residing in assisted living I and II facilities is also limited by the residents' inability to assume responsibility for accessing oral health care. The outcomes from this study may serve to inform policymakers and advocates for access to oral health care as they develop new policies to address this growing need.


Subject(s)
Dental Care for Aged , Dental Hygienists , Needs Assessment , Professional Role , Skilled Nursing Facilities , Aged , Arkansas , Assisted Living Facilities/organization & administration , Attitude of Health Personnel , Attitude to Health , Frail Elderly , Health Education, Dental , Health Personnel/education , Health Personnel/psychology , Health Services Accessibility , Health Status , Humans , Long-Term Care/organization & administration , Nursing Homes , Oral Health , Public Policy , Qualitative Research , Skilled Nursing Facilities/organization & administration , Workforce
15.
J Dent Hyg ; 88 Suppl 1: 13-22, 2014.
Article in English | MEDLINE | ID: mdl-25071146

ABSTRACT

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.


Subject(s)
Dental Care for Children/economics , Medically Underserved Area , School Dentistry/economics , Child , Child, Preschool , Costs and Cost Analysis , Dental Care for Children/instrumentation , Dental Hygienists/economics , Dental Hygienists/education , Direct Service Costs , Female , Health Services Accessibility/economics , Humans , Infant , Infant, Newborn , Male , Medicaid/economics , Missouri , Poverty , Preventive Dentistry/economics , Reimbursement Mechanisms/economics , Students , United States , Vulnerable Populations
16.
J Dent Hyg ; 88(2): 69-77, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24771771

ABSTRACT

PURPOSE: This paper describes the Preventive Services Program (PSP), a community based oral health program model which engages volunteers to provide preventive services and education for underserved children in Missouri. In 2006, the Missouri Department of Health and Senior Services created a program for children designed to use a systems approach for population-based prevention of oral disease. Currently, 5 part-time dental hygienists serve as Oral Health Program Consultants to work with the citizens of a community to engage dentists, dental hygienists, parents and other interested stakeholders in the activities of the program. Dental volunteers evaluate oral health and disease in the community's children and facilitate referrals for dental care. Other volunteers apply fluoride varnish and provide educational services to the children. PROGRAM OUTCOMES: In 2006, 273 volunteer dentists and dental hygienists and 415 community volunteers provided oral screenings, oral health education, 2 fluoride varnish applications and referral for unmet dental care for 8,529 children. In 2011, 775 volunteer dentists and dental hygienists and 1,837 other community volunteers provided by PSP services to nearly 65,000 children. CONCLUSION: It has been demonstrated that when the local citizens take responsibility for their own needs that a sustainable and evidence-based program like PSP is possible. Guidelines which provide criteria for matching models with the specific community characteristics need to be generated. Furthermore, a national review of successful program models would be helpful to those endeavoring to implement community oral health program.


Subject(s)
Community Dentistry/organization & administration , Community Health Services/organization & administration , Dental Care for Children/organization & administration , Dental Caries/prevention & control , Health Education, Dental/organization & administration , Oral Health , Volunteers , Child , Child, Preschool , Dental Hygienists , Dentists , Fluorides, Topical/therapeutic use , Health Promotion , Healthcare Disparities , Humans , Missouri , Models, Organizational , Referral and Consultation , Surveys and Questionnaires , Vulnerable Populations
17.
J Dent Hyg ; 87(5): 289-98, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24158662

ABSTRACT

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.


Subject(s)
Cooperative Behavior , Oral Health , Child , Delivery of Health Care , Dental Care for Children , Health Services Accessibility , Humans , Medicaid , Poverty , United States
18.
J Dent Hyg ; 87(1): 30-7, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23433696

ABSTRACT

PURPOSE: The purpose of this preliminary study was to examine the relationship of caries risk, salivary buffering capacity, salivary pH, salivary quality (flow, consistency) and levels of Streptococcus mutans in relation to cigarette smoking. METHODS: This clinical trial consisted of 53 volunteer patients receiving care in a university based dental hygiene clinic. Participants completed a questionnaire specific to their social history in regards to tobacco use, oral health and dietary history. Measurements of unstimulated saliva were collected followed by collection of stimulated saliva samples. These samples were used to measure salivary pH, buffering capacity and Streptococcus mutans levels. RESULTS: The subject's smoking status was significantly associated with caries risk (p= 0.001), with 25% of the variability of caries risk attributed to smoking. The smoking status was significantly associated with buffering capacity (p=0.025), with 9% of the variability of buffering status attributed to the smoking. Associations between smoking status and salivary pH were not statistically significant. The subject's caries risk was significantly associated with buffering capacity (p= 0.001), with 25% of the variability of caries risk attributed to the buffering capacity. The subject's caries risk was significantly associated with salivary pH (p= 0.031), with 9% of the variability of caries risk attributed to the salivary pH. The Streptococcus mutans test showed no statistical significance (p>0.05) possibly due to the number and low variance in the subjects. CONCLUSION: A relationship between caries risk and smoking, buffering capacity and smoking, and stimulated salivary pH and smoking were concluded. No significance difference (p>0.05) between caries risk and salivary pH, salivary quality and smoking, S. mutans and smoking were noted from the preliminary results.


Subject(s)
Saliva/physiology , Smoking , Streptococcus mutans/isolation & purification , Adult , Buffers , Cariostatic Agents/therapeutic use , Dental Caries/microbiology , Dental Caries Susceptibility/physiology , Dental Plaque Index , Ethnicity , Feeding Behavior , Fluorides/therapeutic use , Humans , Hydrogen-Ion Concentration , Insurance, Dental , Middle Aged , Mouthwashes/therapeutic use , Oral Health , Risk Factors , Saliva/metabolism , Saliva/microbiology , Secretory Rate/physiology , Smoking/physiopathology , Sweetening Agents/administration & dosage , Viscosity , Xylitol/administration & dosage , Young Adult
19.
J Dent Hyg ; 85(3): 181-92, 2011.
Article in English | MEDLINE | ID: mdl-21888775

ABSTRACT

PURPOSE: The purpose of this report is to describe the process and outcomes of a collaborative, comprehensive preventive oral health program between the University of Missouri-Kansas City School of Dentistry, the Olathe School District and an Extended Care Permit I dental hygienist. The report describes the programs collectively working to provide school-based services to disadvantaged children in 4 Title I schools using the community collaborative practice oral health model and tele-dentistry. METHODS: The "Miles of Smiles" clinic was assembled in 4 elementary schools using portable dental equipment. Dental hygiene students, supervised by a dental hygiene faculty member with an extended care permit, provided comprehensive preventive oral health care to unserved and underserved children. RESULTS: Twenty-eight dental hygiene students provided prophylaxis, radiographs, sealants, fluoride varnish, oral health education and nutritional counseling to 339 children in the Miles of Smiles clinic during the 2008 to 2009 academic year. Sixty-three percent of children had decay and were referred to a dentist. Upon re-evaluating at the end of the school year, 11% had begun the transition process of seeking restorative care at a safety net clinic or from a local dentist. CONCLUSION: School based oral health models, using dental hygienists with expanded scopes of practice to provide preventive oral health services and referrals, can serve as one approach to overcoming barriers and reaching vulnerable children that desperately need oral health care. However, transitioning children outside of their school to a safety net clinic or local dentist to receive restorative care was found to be problematic.


Subject(s)
Dental Care for Children , Dental Hygienists/education , Outcome and Process Assessment, Health Care , Preventive Dentistry , School Dentistry , Adult , Child , Community Dentistry , Delivery of Health Care , Female , Health Services Accessibility , Humans , Male , Medically Underserved Area , Oral Health , Program Evaluation , Young Adult
20.
J Dent Hyg ; 85(3): 193-203, 2011.
Article in English | MEDLINE | ID: mdl-21888776

ABSTRACT

PURPOSE: The purpose of this study was to examine the experiences of dental hygiene students providing services to unserved and underserved children in a school-based collaboration between a dental school, school district and Extended Care Permit I (ECP-I) dental hygienist in Kansas. METHODS: Following comprehensive preventive oral health care services to children in 4 schools supervised by an ECP-I dental hygienist, 26 senior dental hygiene students enrolled in the dental hygiene program at the University of Missouri-Kansas City submitted rotation data records and self-reflection journals describing the experience. Using the constant comparative method, 3 faculty researchers unitized the data by identifying key themes. RESULTS: Data from student reflections was aggregated into 5 categories: skill development (46%), awareness (19%), type of experience (15%), description of environment/setting (13%) and role model (7%). CONCLUSION: Participation in well-designed service learning programs is rewarding for students providing the services and works toward developing the skills needed to competently care for the changing needs of society. New models of oral health care and expanded roles for dental hygienists are providing greater access to preventive oral health care in Kansas.


Subject(s)
Dental Care for Children , Dental Hygienists/psychology , Health Services Accessibility , Preventive Dentistry , School Dentistry , Adult , Child , Community Dentistry , Delivery of Health Care , Dental Hygienists/education , Female , Humans , Male , Medically Underserved Area , Oral Health , Outcome Assessment, Health Care , Young Adult
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