Recruitment strategies and retention rates for five National Dental PBRN studies.

Background: We describe a retrospective assessment of practitioner and patient recruitment strategies, patient retention strategies, and rates for five clinical studies conducted in the National Dental Practice-Based Research Network between 2012 and 2019, and practitioner and patient characteristics associated with retention. Methods: Similar recruitment strategies were adopted in the studies. The characteristics of the practitioners and patients are described. The proportion of patients who either attended a follow-up (FU) assessment or completed an online assessment was calculated. For studies with multiple FU visits or questionnaire assessments, rates for completing each FU were calculated, as were the rates for completing any and for completing all FU assessments. The associations of practitioner and patient characteristics with all clinic FU visits, and with the completion of all assessments for a study were ascertained. Results: Overall, 591 practitioners and 12,159 patients were included. FU rates by patients for any assessment varied from 91% to 96.5%, and rates for participating in all assessments ranged from 68% to 87%. The mean total number of patients each practitioner recruited was 21 (sd = 15); the mean number per study was 13 (sd = 7). For practitioners, practice type and patient enrollment were associated with greater clinic retention, while only race was associated with their patients completing post-visit online assessments. For patients, age was associated with clinic retention, while female gender, age, race, and education were all associated with greater completion of post-visit online assessments. Conclusion: The Network efficiently recruited practitioners and patients and achieved high patient retention rates for the five studies.

Characteristics of dentists in the National Dental Practice-Based Research Network.

OBJECTIVES: Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures. METHODS: Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics. RESULTS: Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%). CONCLUSIONS: Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients. CLINICAL SIGNIFICANCE: Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.

Feedback on audit and action planning for dental caries control: a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams.

Introduction: American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. Methods: The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Results: Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. Conclusions: The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents.

Feasibility and acceptability of home delivery of water for dental caries control in Latinx children-"Sediento por una Sonrisa," Thirsty for a Smile: Single-arm feasibility study.

Background: Outcomes of surgical treatments under general anesthesia for early childhood caries of young children from low-income groups are poor requiring retreatment within 2 years. Dietary sugar is an ideal intervention target given that it is the most prominent risk factor for dental caries and there is increasing evidence of successful interventions to reduce its intake. Our aim is to investigate the feasibility and acceptability of the Thirsty for a Smile intervention, designed to promote consumption of water in lieu of sugar sweetened beverages, among children who underwent surgery for early childhood caries and their caregivers, mostly from Latino heritage. Methods: A single-arm feasibility study was conducted in a dental practice from a community health center in eastern Washington State. Bottled water was delivered to the participants' homes and caregivers received patient-centered counseling for setting goals to increase children's water intake and reduce sugar sweetened beverages consumption. We assessed the feasibility and acceptability of the intervention and study procedures through participation rates, interviews and a questionnaire completed by the caregivers. Data was analyzed and themes and descriptive statistics presented. Results: Twenty-two dyads of caregivers and their children between 2 and 9 years old who recently had surgical treatment for early childhood dental caries were enrolled. All study assessments were completed by more than 90% of participants, except for the final 24-h dietary recall (73%). Dietary counseling, both in person and brief telephone calls, was highly acceptable to the caregivers, and they also reported their children enjoyed and used the water bottles. On a scale from 1 to 10, the average rating for the helpfulness of the dietary counseling component for changing child's drinking habits was 9.62 and for the water delivery component, 8.86. Conclusions: This study tested the feasibility of conducting a trial in a dental practice setting, and the acceptability among caregivers of young children who underwent surgery for early childhood caries. It demonstrated that the Thirsty for a Smile intervention and study processes were feasible and acceptable. The study provides useful information for implementation of a two-arm randomized controlled trial in this setting and may also benefit other researchers attempting to test similar interventions.

Structure, function, and productivity from the National Dental Practice-Based Research Network.

Introduction: Following inception in 2005 as a multiregional practice-based research network (PBRN), the "National Dental PBRN" expanded nationwide in 2012, and in 2019 implemented additional organizational changes. The objectives are to: (1) describe the new structure and function of the network; and (2) quantify its scientific productivity since 2005. Methods: A national Administrative and Resource Center is based in Alabama; regional and specialty nodes are based in Alabama, Florida, Illinois, Minnesota, Oregon, New York, and Texas. A Network Coordinating Center is based in Oregon. Studies are funded via investigator-initiated grants. Scientific productivity is assessed using specific metrics, including the Relative Citation Ratio. Results: To date, 58 studies have been completed or are in data collection or development. These studies have investigated a broad range of topics using a wide variety of study designs. Of the studies that have completed enrollment, 70,665 patients were enrolled, as were 19,827 practitioners (some participated in multiple studies), plus electronic records for 790,493 patients in two data-only studies. To date, these studies have led to 193 peer-reviewed scientific publications in 62 different journals. The mean (1.40) Relative Citation Ratio of Network publications connotes a greater-than-average influence in their fields. Conclusions: These metrics demonstrate that the PBRN research context can successfully engage practitioners and patients from diverse settings nationally with a high and sustained level of scientific productivity. This infrastructure has enabled clinical scientists in oral health and nonoral health topics and provided additional recruitment venues outside of the typical academic health center research context.

Home Delivery of Water for Caries Prevention in Latinx Children ("Sediento por una Sonrisa," Thirsty for a Smile): Protocol for a Single-Arm Feasibility Study.

BACKGROUND: Dental caries has significant public health implications afflicting young children. In addition to low social economic status, the most prominent risk factor for early childhood caries is sugar in the diet, particularly sugar-sweetened beverages. Dental treatment for caries in young children is commonly performed under general anesthesia and a significant proportion of children require repeated treatment. Interventions to reduce sugar-sweetened beverage consumption could lead to reduced rates of retreatment for dental caries in young children. OBJECTIVE: This protocol describes the rationale, design, and methods of the "Thirsty for a Smile" feasibility study. The aim of the study is to assess the feasibility, acceptability, and appropriateness of a dietary intervention promoting water consumption in lieu of sugar-sweetened beverages among young patients, mostly from Latino heritage. METHODS: This protocol describes a single-arm feasibility study. Twenty-one dyads of children and their caregivers will be recruited. Children between 2 and 9 years old who recently had treatment under general anesthesia for early childhood dental caries will be eligible to participate. The intervention has two components: (1) environmental, in which bottled water is delivered to participants' homes; and (2) behavioral, in which caregivers will receive patient-centered counseling to increase children's water intake and reduce sugar-sweetened beverages consumption. Dental caries and anthropometric data will be collected at examination during baseline and final visits. The primary outcome is feasibility and secondary outcomes are acceptability and appropriateness of the intervention. RESULTS: Funding has been obtained from the National Institute of Dental and Craniofacial Research and the University of Washington approved the study. The feasibility study was conducted from March to November 2019. CONCLUSIONS: This feasibility study will test the study processes prior to a two-arm randomized controlled trial to determine feasibility and acceptability of the intervention and study procedures. This study may provide useful information for other researchers attempting to test similar interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/37200.

Teledentistry: An Adjunct for Delivering Dental Care in Crises and Beyond.

Teledentistry can play a viable role both during a public health emergency and in everyday practice, contributing to sustaining, building, and improving dental practices as well as addressing health inequities. In light of the COVID-19 pandemic, which has caused widespread disruptions in the delivery of dental care, Oregon Health and Science University (OHSU) and the University of Washington (UW) implemented virtual care programs to help mitigate challenges associated with access to care. This article outlines a practical workflow for dentists to embark on teledentistry.

Medical-Dental Integration in a Rural Community Health Center: A Qualitative Program Evaluation.

BACKGROUND: A community health center (CHC) implemented a medical-dental integration (MDI) program where children were seen at a pediatric medical clinic or women, infants, and children program location by medical and dental providers in the same visit. Our study aims were to elicit the perspectives and experiences of providers and administrators involved in the MDI program to assess the acceptability, feasibility, and success of a CHC integration strategy in Eastern Washington. METHODS: This is a qualitative study where we conducted semistructured interviews over the phone over a period of 2 months with 12 medical and dental providers and clinical administrators who were involved with the MDI program. Questions addressed perspectives on workflow, patient identification and engagement, leadership support, and barriers and facilitators of the initiative. Qualitative data were analyzed, and emergent themes were identified. RESULTS: The emergent themes included (a) the MDI program is feasible and acceptable albeit with key considerations regarding the setting, including charting and service integration, progressive leadership and effective communication, and appropriate providers; (b) implementation included structural, systemic, and individual behavior barriers, (c) the program is seen as a benefit to the clinic and patients and a success to date as a way to increase access to quality care. CONCLUSIONS: Findings from this study helped identify facilitators, such as cultural relevancy and progressive office systems, as well as barriers, such as reimbursement, associated with integrating medical and dental care in a rural CHC setting, is acceptable by providers, and can inform future studies and implementation strategies for others wishing to integrate these services.

EFFECT OF MUSCULOSKELETAL DISORDERS AND ORGANIZATIONAL CLIMATE ON WELL-BEING OF DENTAL HYGIENISTS.

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Impacts of innovation in dental care delivery and payment in Medicaid managed care for children and adolescents.

BACKGROUND: We evaluated a 14-county quality improvement program of care delivery and payment of a dental care organization for child and adolescent managed care Medicaid beneficiaries after 2 years of implementation. METHODS: Counties were randomly assigned to either the intervention (PREDICT) or control group. Using Medicaid administrative data, difference-in-difference regression models were used to estimate PREDICT intervention effects (formally, "average marginal effects") on dental care utilization and costs to Medicaid, controlling for patient and county characteristics. RESULTS: Average marginal effects of PREDICT on expected use and expected cost of services per patient (child or adolescent) per quarter were small and insignificant for most service categories. There were statistically significant effects of PREDICT (p < .05), though still small, for certain types of service: (1) Expected number of diagnostic services per patient-quarter increased by .009 units; (2) Expected number of sealants per patient-quarter increased by .003 units, and expected cost by $0.06; (3) Total expected cost per patient-quarter for all services increased by $0.64. These consistent positive effects of PREDICT on diagnostic and certain preventive services (i.e., sealants) were not accompanied by increases in more costly service types (i.e., restorations) or extractions. CONCLUSION: The major hypothesis that primary dental care (selected preventive services and diagnostic services in general) would increase significantly over time in PREDICT counties relative to controls was supported. There were small but statistically significant, increases in differential use of diagnostic services and sealants. Total cost per beneficiary rose modestly, but restorative and dental costs did not. The findings suggest favorable developments within PREDICT counties in enhanced preventive and diagnostic procedures, while holding the line on expensive restorative and extraction procedures.

Caries experience in caregiver-intellectual deficient pair: Influence of caregiver's psychological morbidity.

OBJECTIVE: Evaluate how determinants of psychological morbidity were associated with dental caries experience in the caregiver-intellectual deficient pair. METHODS: A cross-sectional study with 299 pair, who had their oral health status assessed using the DMFT index (decayed, missing and filled teeth). Symptoms of anxiety, depression, stress, quality of sleep, and socioeconomic variables were measured in caregivers. Adjusted prevalence ratios were estimated using Poisson regression with the caregiver and children's caries index as outcome. RESULTS: The average prevalence of DMFT/dmft was 7.48 (SD ± 3.9) for students with ID and DMFT was 14.7 (SD ± 8.1) for their caregivers. For the caregiver's oral health, the following psychic comorbidities were associated with worse oral health condition: anxiety (PR = 1.48; 95%CI 1.07-2.06), depression (PR = 1.39; 95%CI 1.05-1.85), high level of stress (PR = 1.58; 95%CI 1.17-2.13) and sleep disorders (PR = 1.59; 95%CI 1.18-2.14). For people with ID, the caregiver's psychic comorbidities also showed association with a worse oral health condition, including anxiety (PR = 1.31; 95%CI 1.03-1.74), depression (PR = 1.28; 95%CI 1.01-1.67) and high level of stress (PR = 1.63; 95%CI 1.14-2.32), as well as mother's high level of DMFT (PR = 1.96; 95%CI 1.28-3.03). CONCLUSION: Symptoms of depression, anxiety and stress were associated with higher levels of dental caries experience for caregivers and for people with intellectual disabilities.

Professionally and Self-Applied Fluorides are Effective in Preventing Dental Root Caries.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis. Zhang J, Sardana D, Li KY, Leung KCM, Lo ECM. J Dent Res. 2020; 99(5):506-13. SOURCE OF FUNDING: Other funding. The study was funded by the Tam Wah-Ching endowed professorship of the University of Hong Kong. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Is dietary pattern a mediator of the relationship between socioeconomic status and dental caries?

OBJECTIVE: To investigate whether a healthy diet and added sugar mediate the relationship between socioeconomic status and oral health status in adults. METHODS: This is a secondary cross-sectional analysis of adult participants from the 2015-2016 National Health and Nutrition Examination Survey from the United States (n=3367). Structural equation modeling tested direct and indirect pathways from a latent variable for socioeconomic status to oral health via healthy eating (Health Eating Index) and added sugar in a multiple-mediator multiple-outcome model. RESULTS: Added sugar was directly associated with untreated dental caries [Standardized coefficient (SC)=0.10], and healthy eating was directly associated with both untreated dental caries (SC=-0.11) and tooth loss (SC=-0.05). Higher socioeconomic status was associated with lower untreated dental caries through direct (SC =-0.246) and small indirect paths via healthy diet (SC= -0.026), lower consumption of added sugar (SC=-0.007), and dental visits (SC=-0.162). Higher socioeconomic status was associated with fewer teeth lost through direct (SC =-0.306) and very small indirect paths via healthy diet (SC=-0.016), added sugar consumption (SC=-0.001), and untreated dental caries (SC=-0.094). CONCLUSIONS: Both socioeconomic status and dietary pattern independently contributed to tooth loss and dental caries. The contribution of dietary factors as a mediator to socioeconomic inequities in oral health was small, and statistically significant. CLINICAL RELEVANCE: A systems approach to socioeconomic inequities in oral health takes into account the complex relationships between socioeconomics, dietary patterns, oral health and health. Socioeconomic conditions and nutrition, as common risk factors to noncommunicable disorders, should be tackled in programs to improve oral health.

Food processing and its association with dental caries: Data from NHANES 2011-2014.

OBJECTIVE: To assess whether proportional contribution of unprocessed or minimally processed, processed or ultra-processed foods to daily energy intake is associated with dental caries in US adults. METHODS: This secondary cross-sectional analysis included adults aged 20 to 59 years old with complete oral examinations, using data gathered from cycles 2011-2012 and 2013-2014 of the continuous National Health and Nutrition Examination Survey (NHANES). Dietary recall data were categorized according to the NOVA classification into four groups: unprocessed or minimally processed foods (Group 1), processed culinary ingredients (Group 2), processed foods (Group 3) and ultra-processed foods (Group 4). The proportional contribution of each of these groups to mean daily energy intake was calculated and then cut into quartiles (Group 1, Group 3 and Group 4) or tertiles (Group 2). Two separate measures were used to assess dental caries: the decayed, missing, filled teeth (DMFT) index and, after exclusion of edentulous participants, prevalence of untreated caries. Poisson regression was used to model DMFT, while logistic regression was used to model the prevalence of untreated dental caries. Models were calculated for each NOVA group. All models were controlled for age, gender, race/ethnicity, level of education, income, access to oral health services, body mass index, smoking status and total energy intake. Analyses took into account NHANES sampling weights. RESULTS: We analysed data from 5720 individuals, of whom 123 (2.2%) were edentulous. Mean DMFT was 9.7 (± 0.2), while the prevalence of untreated dental caries was 26.0%. Mean daily energy intake was 2170 kcal (± 17). Mean contribution to overall daily energy intake was 28.6% (± 0.5) for G1 foods, 4.3% (± 0.1) for G2 foods, 10.1% (± 0.2) for G3 foods and 56.9% (± 0.5) for G4 foods. A higher intake of G3 was associated with lower DMFT at the fourth quartile (0.89; 95%: CI 0.81-0.96), while a higher intake of G4 was associated with a higher DMFT at the fourth quartile (1.10; 95% CI: 1.04-1.16). In the adjusted models for untreated dental caries, no statistically significant associations were found with any of the NOVA groups. CONCLUSION: Higher proportional intake of NOVA groups is only weakly associated with dental caries. Widespread exposure to a highly ultra-processed diet may explain these weak associations.

Evaluation of Training Gaps Among Public Health Practitioners in Washington State.

CONTEXT: Identifying training gaps in public health competencies and skills is a first step in developing priorities for advancing the workforce. OBJECTIVE: Our purpose was to identify training gaps in competencies and skills among local, state, and nonjurisdictional public health employees in Washington State. Our secondary aim was to determine whether training gaps differed by employees' work-related and demographic characteristics. DESIGN: We used data from our training needs assessment of the public health workforce, conducted as an online cross-sectional survey in Spring/Summer of 2016. RESPONDENTS AND SETTING: Employees from governmental local, state, and nonjurisdictional public health departments in Washington State. MAIN OUTCOME MEASURES: Training gaps were calculated for 8 public health competencies and 8 skills, using a composite score of respondents' ratings of their "training confidence" and "training need." For each domain and skill area, we calculated the percentage of associated items, where respondents rated their training needs as high and their confidence as low to create scores ranging from 0% to 100%. RESULTS: The largest training gaps in public health competencies were in the Financial Planning and Policy Development domains. For skills, Quality Improvement and Developing Effective Communication Campaigns had the largest training gaps. In adjusted models, female employees or employees working in local health departments in select Washington State regions had higher training gaps in Financial Planning, Policy Development, and Quality Improvement, relative to male or state health department employees. Employees who worked in specialized programs, such as Communicable Disease Control, and Maternal, Child, and Family Health, had higher training gaps in Financial Planning and Developing Effective Communication Campaigns than those who worked in Administrative and Support Services. CONCLUSIONS: We identified important training gaps in several competency domains and skills. Findings are informing decisions about tailoring training opportunities for public health practitioners in Washington and other states.

Parents' Satisfaction with Silver Diamine Fluoride Treatment of Carious Lesions in Children.

Purpose: Current national evidence-based recommendations for treatment of carious lesions include the use of 38 percent silver diamine fluoride (SDF). The purpose of this study was to learn parents' opinions of esthetic changes to their children's teeth following treatment with SDF.
Methods: Three-hundred nineteen parents who had previously consented to SDF for caries arrest or caries prevention were asked if their child received SDF, if they noticed changes because of SDF, and how "bothered" they were by the changes.
Results: Two-hundred ten parents reported their child received SDF in the past 12 months, of whom 76 percent were confirmed by Codes on Dental Procedures and Nomenclature (CDT): 115 children received SDF for caries arrest and 45 received topical fluoride (SDF) for prevention. Of all 210 who reported SDF, 30 percent described discoloration of their child's teeth or gingiva. On a scale of zero (not bothered at all by changes due to SDF) to 10 (very bothered), parents' average rating was 1.2 ipoints; the average within the caries arrest group was 1.7.
Conclusion: Dental treatment requires a shared decision between parents and professionals, and follow-up regarding new procedures is warranted. In this study, treatment with SDF was well accepted by most parents.

Limited Evidence Suggests That Many Types of Desensitizing Toothpaste May Reduce Dentin Hypersensitivity, but Not the Ones With Strontium or Amorphous Calcium Phosphate.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effect of desensitizing toothpastes on dentine hypersensitivity: A systematic review and meta-analysis. Hu M-L, Zheng G, Zhang Y-D, Yan X, Li X-C, Lin H. J Dent (2018)75:12-21. SOURCE OF FUNDING: The authors reported that this research did not receive any specific funding from the public, commercial, or not-for-profit sectors. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.