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Introduction: Mental health conditions and poor oral health outcomes share bidirectional links, and both are linked to factors related to socioeconomic position (SEP). We used nationally representative survey data to describe the complex interplay of SEP, mental health, oral health behaviors, dental treatment seeking, and oral health., Methods: We used data from the 2022 State of Oral Health Equity in America survey, which collects data from US adults on prior depression diagnosis and current depressive symptoms via the Patient Health Questionnaire-9 and demographic characteristics (age, sex/gender, race, ethnicity), SEP (education, income, employment, home ownership, dental insurance), oral health behaviors (brushing and flossing frequency), dental treatment seeking (time since last visit, plans for visit in the coming year), and self-rated oral health (feeling self-conscious due to poor oral health, having symptoms of poor oral health). We used structural equation modeling to identify latent variables and fit the path analytic models., Results: In the total sample (N = 5,682), SEP was significantly associated with dental treatment seeking (standardized parameter estimate [SE] = 0.55 [0.05]), oral health behaviors (standardized parameter estimate [SE] = 0.34 [0.04]), and mental health (standardized parameter estimate [SE] = 0.59 [0.05]). These factors, in turn, were significantly associated with self-rated oral health (estimates ranging from 0.20 to 0.54, SEs ranging from 0.04 to 0.05)., Conclusion: SEP, which involves several major social determinants of health, is directly associated with mental health and indirectly associated with self-rated oral health status, with mental health modifying the relationship between SEP and self-rated oral health. Findings emphasize the need to integrate medical, dental, and behavioral health with the goal of providing comprehensive person-centered care.

In this 2019 cross-sectional study, we analyzed hospital records for Medicaid beneficiaries who acquired nonventilator hospital-acquired pneumonia. The results suggest that preventive dental treatment in the 12 months prior or periodontal therapy in the 6 months prior to a hospitalization is associated with a reduced risk of NVHAP.

Background: Diabetes mellitus (DM) and periodontal disease have a suggested bidirectional relationship. Researchers have reported decreases in DM-related health care costs after periodontal treatment. The authors examined the relationship between periodontal disease treatment and DM health care costs in commercial insurance and Medicaid claims data., Methods: This study of IBM MarketScan commercial insurance and Medicaid databases included overall outpatient, inpatient, and drug costs for patients with DM. The authors examined associations between overall health care costs per patient in 2019 according to use of periodontal services from 2017 through 2018 using generalized linear modeling. The average treatment effect on treated was calculated by means of propensity score matching using a logistic model for periodontal treatment on covariates., Results: For commercial insurance enrollees, periodontal treatment was associated with reduced overall health care costs of 12% compared with no treatment ($13,915 vs $15,739; average treatment effect on treated, -$2,498.20; 95% CI, -$3,057.21 to -$1,939.19; P < .001). In the Medicaid cohort, periodontal treatment was associated with a 14% decrease in costs compared with patients with DM without treatment ($14,796 vs $17,181; average treatment effect on treated, -$2,917.84; 95% CI, -$3,354.48 to -$2,480.76; P < .001). There were no significant differences in inpatient costs (commercial insurance) or drug costs (Medicaid)., Conclusions: Undergoing periodontal treatment is associated with reduced overall and outpatient health care costs for patients with DM in Medicaid and commercial insurance claims data. There were no significant differences in inpatient costs for commercial insurance enrollees or in drug costs for Medicaid beneficiaries., Practical Implications: A healthy mouth can play a key role in DM management. Expanding Medicaid benefits to include comprehensive periodontal treatment has the potential to reduce health care costs for patients with DM., (Copyright © 2023 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the use of Medicaid and commercial claims data with self-reported survey data in estimating the prevalence of oral disease burden., Methods: We analyzed 2018 Medicaid claims from the IBM Watson Medicaid Marketscan database, commercial claims from the IBM Dental Database, and Medical Expenditure Panel Survey (MEPS) data. The estimate of oral disease burden was based on standard metrics using periodontal and caries-related Current Dental Terminology (CDT) procedure codes. A direct comparison between the data sets was also done., Results: Unweighted Medicaid and commercial enrollees were 11.6 and 10.5 million, respectively. The weighted proportion from MEPS for Medicaid and commercial plans ranged from 80 to 208 million people. Estimates of caries-related treatments were calculated from IBM Watson and MEPS data for Medicaid enrollees (13% vs. 12%, respectively) and commercial claims (25% vs. 17%, respectively). Prevalence of periodontal related treatments for those with a dental visit was estimated for IBM Watson and MEPS enrollees for Medicaid (0.7% vs. 0.5%, respectively) and commercial claims (7% vs. 1.6%, respectively). Dental disease estimates were higher in individuals with at least one dental visit across cohorts. Prevalence of disease for those with a dental visit based on specific procedures were higher in commercial plans than in Medicaid., Conclusions: Claims data has the potential to serve as a proxy measure for the estimate of dental disease burden in a population., (© 2022 American Association of Public Health Dentistry.)

Background: This study compared prevalence, incidence, mortality rates, treatment costs, and risk factors for oral and oropharyngeal cancer (OC/OPC) between two large United States adult cohorts in 2012-2019., Methods: Medicaid and commercial claims data came from the IBM Watson Health MarketScan Database. Logistic regression analyses estimated incidence and risk factors for OC/OPC. Mortality was calculated by merging deceased individuals' files with those of the existing cancer cohort. Summing costs of outpatient and inpatient services determined costs., Results: Prevalence of OC/OPC in Medicaid enrollees decreased each year (129.8 cases per 100,000 enrollees in 2012 to 88.5 in 2019); commercial enrollees showed a lower, more stable prevalence (64.7 per 100,000 in 2012 and 2019). Incidence trended downward in both cohorts, with higher incidence in the Medicaid (51.4-37.6 cases per 100,000) than the commercial cohort (31.9-31.0 per 100,000). Mortality rates decreased for Medicaid enrollees during 2012-2014 but increased in the commercial cohort. OC/OPC treatment costs were higher for commercial enrollees by $8.6 million during 2016-2019. OC/OPC incidence was higher among adults who were older, male, and white; used tobacco or alcohol; or had prior human immunodeficiency virus/acquired immune deficiency syndrome diagnosis and lower among those who had seen a dentist the prior year., Conclusions: Medicaid enrollees experienced higher OC/OPC incidence, prevalence, and mortality compared with commercially insured adults. Having seen a dentist within the prior year was associated with a lower risk of OC/OPC diagnosis., Impact: Expanding Medicaid dental benefits may allow OC/OPC to be diagnosed at earlier stages through regular dental visits., (©2022 The Authors; Published by the American Association for Cancer Research.)

Objective: To ascertain the financial impact associated with the underutilization of preventive dental care for adults enrolled in Medicaid., Methods: We used adult claims data for patients aged 21-64 in the IBM Watson Marketscan Medicaid database. Enrollees were included if they had at least one dental claim in 2019 and were continuously enrolled between 2014 and 2019. We then evaluated the costs of their dental care in 2019, based on the number of years of preventive dental care they received between 2014 and 2018. We also assessed Emergency Department (ED) utilization for dental conditions, oral surgeries, and dental-related opioid prescriptions., Results: The average Medicaid enrollee with five continuous years of preventive care prior to 2019 experienced 43% lower costs than an individual who received no preventive dental care at all. Most of the savings were a result of fewer oral surgeries. A Medicaid enrollee with no preventive dental visits was eight times more likely to have an ED visit for a nontraumatic dental condition (NTDC), seven times more likely to have oral surgery and six times more likely to receive a dental-related opioid prescription compared to those who had a dental prevention visit every year in the 5-year lookback period., Conclusions: Regular preventive dental care in the lookback period was associated with significant savings in overall dental care costs when compared to dental care costs for those individuals who received no or few preventive visits. Prior preventive dental care was also associated with lower rates of ED-NTDC utilization, oral surgery, and dental-related opioid prescriptions., (© 2022 The Authors. Journal of Public Health Dentistry published by Wiley Periodicals LLC on behalf of American Association of Public Health Dentistry.)

Aim: The Child Dental Control Assessment (CDCA) measures children's preferred control strategies in the dental situation. Three studies are reported, assessing aspects of this instrument in youths from the USA, Japan and Australia. In particular, measurements were made as to the reliability and validity of this instrument in this age group in the three cultures, as well as comparing some results across cultures., Study Design: These studies used a questionnaire design., Methods: Questionnaires (including the CDCA and other measures) were given to youths aged 11-15 in the three cultures. In one culture, youths received the questionnaire twice, to compute test-retest reliability., Results: The measure's reliability and validity were similar to those of other measures. The CDCA behaves similarly to the Revised Iowa Dental Control Index (R-IDCI). Youths in all three cultures showed similar responses, although the Japanese were less likely to endorse items., Statistics: Internal reliability of the scale ranged from 0.74 to 0.85. Test- retest reliability was 0.74. Participants in the High Desire/Low Predicted classification on the R-IDCI scored higher on the CDCA (t (73) = 2.9, p < .01). In the Japanese and Australian samples the correlation between CDCA and dental fear was 0.29-0.33 (p < .001). The Australian and USA samples scored significantly higher than the Japanese sample (overall F(2,1544) = 383.98, p < .001, followed by Tukey's HSD, p < .001)., Conclusions: These results provide evidence for the reliability and validity of the CDCA in youth. It appears to measure the discrepancy between Desired and Predicted Control identified in the Revised Iowa Dental Control Index (R-IDCI). Responses of the youth in all three cultures were similar, indicating common dental control preferences for individuals of this age. However, consistent with cultural values, Japanese youth were less likely to endorse the control strategies. These results underline the need to develop culturally-specific, as well as situationally-specific control measures.

Background: Dental anxiety has been a well-studied phenomenon since the late 1960s. The purpose of this literature review was to compare self-reported levels of dental anxiety during the past 50 years., Methods: The authors reviewed more than 200 articles and examined 19 studies involving more than 10,000 adults to assess any trends in dental anxiety. They investigated mean anxiety scores for college students and general adult samples using four measures of dental anxiety. Comparisons were made across publication year and location of study., Results: Analyses of variance suggest stability in dental anxiety scores over time and region within both types of study samples. Regardless of assessment length (single item or multi-item), the authors found no significant trends suggesting an increase or decrease in self-reported anxiety levels., Conclusions: These results suggest that despite an increase in general anxiety within the United States during the past 50 years, dental anxiety seems to have remained stable throughout the period., Practice Implications: The authors discuss the stable trend of self-reported dental anxiety levels in the context of increasing general anxiety in the United States and the current structure of individual dental practices.

Purpose: This study was conducted to investigate the characteristics of and opinions about the selection process of applicants to residency programs in oral and maxillofacial surgery (OMS) in the year 2000. The current investigation paralleled a survey completed in the 1970s, with additional questions to assess contemporary curriculum and surgical training evolution. Differences from the previous (1976) survey, a profile of applicants in 2000, and characteristics of OMS residency programs that applicants view as attractive are discussed., Subjects and Methods: Questionnaires were sent to 307 applicants to OMS residency programs registered in the dental matching program. To provide a more direct comparison of the study completed in 1977, the current questionnaire used the original survey as a model. It was divided into 6 sections: general information, information from the formal application and letters of recommendation, the interview, the selection process, the characteristics applicants were seeking in a program, and a retrospective review of programs visited., Results: In this study, 118 responses were received, representing 38% of the total. Respondents were predominately men (86%) and single, and attended dental school in all regions of the United States and the world. Respondents listed geographic location (65%) and national reputation (58%) as important factors for selecting programs to which to apply. Many respondents felt that a previous dental internship (85%), national board scores (83%), and class rank (79%) would be considered important in screening applicants for interview. A program's reputation, personalities of residents and attending staff, and clinical material were ranked as important factors contributing to program selection. Fifty-three of the 79 successful applicants reported that they were matched with their first-choice institution. Sixty percent of programs were considered worthy of revisiting by the respondents., Conclusions: Respondents in 2000 had more knowledge of the selection process before interviewing and submitted 2 times the number of applications than applicants in 1977. When selecting programs to which to apply, current applicants were less influenced by geographic location and the recommendations of other dentists. Applicants were attracted to programs that they perceive to have a good reputation and abundant clinical material. Residencies that convey a friendly atmosphere, favorable interpersonal skills of enrolled residents, and appealing personalities of the faculty were more attractive to candidates., (Copyright 2003 American Association of Oral and Maxillofacial Surgeons)