Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon-Kuskokwim Delta.

OBJECTIVES: Dental Health Aide Therapists (DHATs) have been part of the dental workforce in Alaska's Yukon-Kuskokwim (YK) Delta since 2006. They are trained to provide preventive and restorative care such as filling and extractions. In this study, we evaluated community-level dental outcomes associated with DHATs. METHODS: This was a secondary data analysis of Alaska Medicaid and electronic health record data for individuals in Alaska's YK Delta (2006-2015). The independent variable was the number of DHAT treatment days in each community. Child outcomes were preventive care, extractions, and general anesthesia. Adult outcomes were preventive care and extractions. We estimated Spearman partial correlation coefficients to test our hypotheses that increased DHAT treatment days would be associated with larger proportions utilizing preventive care and smaller proportions receiving extractions at the community-level. RESULTS: DHAT treatment days were positively associated with preventive care utilization and negatively associated with extractions for children and adults (P < 0.0001). DHAT treatment days were not associated with increased dental treatment under general anesthesia for children. CONCLUSIONS: Dental therapists are associated with more preventive care and fewer extractions. State-level policies should consider dental therapists as part of a comprehensive solution to meet the dental care needs of individuals in underserved communities and help achieve health equity and social justice.

Weather-Related Hazards and Population Change: A Study of Hurricanes and Tropical Storms in the United States, 1980-2012.

Environmental determinists predict that people move away from places experiencing frequent weather hazards, yet some of these areas have rapidly growing populations. This analysis examines the relationship between weather events and population change in all U.S. counties that experienced hurricanes and tropical storms between 1980 and 2012. Our database allows for more generalizable conclusions by accounting for heterogeneity in current and past hurricane events and losses and past population trends. We find that hurricanes and tropical storms affect future population growth only in counties with growing, high-density populations, which are only 2 percent of all counties. In those counties, current year hurricane events and related losses suppress future population growth, although cumulative hurricane-related losses actually elevate population growth. Low-density counties and counties with stable or declining populations experience no effect of these weather events. Our analysis provides a methodologically informed explanation for contradictory findings in prior studies.

Modern acoustic reflectometry: accuracy in diagnosing otitis media with effusion.

We conducted a study of 80 patients to evaluate the accuracy of a commercially available acoustic reflectometer in identifying the presence or absence of otitis media with effusion (OME). This device assesses bilateral tympanic membrane mobility and, by inference, middle ear status. We found that it was most accurate in patients with normal and grossly fluid-filled ears. We recommend screening with this acoustic reflectometer to rule out OME in adult and pediatric patients.

Submandibular gland squamous metaplasia mimicking recurrent squamous cell carcinoma: diagnostic dilemma.

New masses in the head and neck region of previously treated patients with cancer are considered suggestive of potential recurrence. Fine-needle aspiration is an excellent primary tool for evaluating these masses but may show atypical squamous cells that mislead clinicians to pursue aggressive treatment. We describe 3 patients in whom submandibular gland masses developed after radiation therapy for squamous cell carcinoma and for whom subsequent excisional biopsy findings showed benign squamous metaplasia. We review distinguishing clinical and histopathologic features that may allow these lesions to be identified. We also propose a treatment algorithm for this uncommon clinical scenario.