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Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dental hygienists (DHs) are well positioned to be part of primary care teams to increase access to oral health care, particularly for those who encounter barriers to oral care, such as pregnant people. The Michigan Initiative for Maternal and Infant Oral Health (MIMIOH) integrates DHs into obstetrics and gynecology (OB/GYN) clinics in federally qualified health centers (FQHCs) to improve pregnant people's oral health. Evaluation of the MIMIOH program revealed that selecting DHs with personal characteristics desirable for integrated-care delivery was a major factor for successfully integrating DHs into OB/GYN clinics. Additionally, designing appropriate clinical workflows, gaining buy-in from prenatal health care professionals, presenting oral health care as part of prenatal care, having co-located OB/GYN and dental clinics, and maintaining adequate funding were all critical to program success. Analysis of Medicaid data showed that the MIMIOH model increased the percentage of pregnant people receiving oral health care at FQHC dental clinics. Innovative programs like MIMIOH add to the evidence that integrating DHs into primary care settings can increase access to oral health care, especially for those who face difficulties accessing the traditional oral health care system. There is great potential for DHs to leverage collaborative practice agreements and remote supervision to increase access to oral health care for the public. Providing DHs with autonomy to practice to the highest level of their scope of practice and permitting direct Medicaid reimbursement for DHs would make oral health care more accessible for underserved populations. [ABSTRACT FROM AUTHOR]

Income inequality has been associated with worse oral health outcomes and reduced dental care use. It is unknown whether income inequality may motivate people to seek orthodontic treatment. This was a logistic mixed-effects model of deidentified claims from a private insurer in the United States with enrolled members having at least 1 orthodontic visit in the calendar year as the dependent variable. Total number of dental visits, age, and sex were individual-level covariates. Median household income, Gini coefficient, female population proportion, number of practicing dentists and orthodontists, population size, and population density were zip code-level covariates. A total of 1,860,709 people had at least 1 orthodontic claim. Adjusting for population demographics, the Gini index was significantly positively associated with orthodontic use for children but not for adults (odds ratio, 1.69 for children; P <.0001). Being female was the strongest predictor of orthodontic use for adults and was a significant predictor of use for children (odds ratio, 1.50 and 1.45, respectively; P <.0001). The Gini index is associated with orthodontic use in children in a privately insured population. Individual characteristics are more predictive of orthodontic use among privately insured adults. Demographic and economic traits of communities can affect oral health care use; effects on orthodontic use may be more dramatic than on other forms of oral health care. [ABSTRACT FROM AUTHOR]

Background. Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children's preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics. Methods. Data for this observational, cross-sectional study came from the 2016 National Survey of Children's Health. Children aged 2 through 17 years were included (n = 46,100). Caregiverreported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted. Results. As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care. Conclusions. Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services. Practical Implications. Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

Background. In this study, the authors report on the geospatial distributions of periodontists and adults with severe periodontitis in the United States. Methods. The authors used geospatial analysis to describe the distribution of periodontists and adults, periodontists vis-a-vis estimated density of adults with severe periodontitis, and their ratios to adults with severe periodontitis. The authors identified locations of 5,415 practicing periodontists through the 2014 National Provider Identifier Registry, linked them with the weighted census number of adults, and estimated the number of adults within a series of circular distance zones. Results. Approximately 60% of adults 30 through 79 years lived within 5 miles of a periodontist, 73% within 10 miles, 85% within 20 miles, and 97% within 50 miles. Proximity to a periodontist varied widely. In urban areas, 95% of adults resided within 10 miles of a periodontist and 100% within 20 miles. Only 24% of adults in rural areas lived within 10 miles of a periodontist. Most periodontists (96.1%) practiced in urban areas, clustering along the eastern and western coasts and in the Midwest, 3.1% in urban clusters elsewhere, and 0.8% in rural areas. Ratios of fewer than 8,000 adults with periodontitis to 1 or more periodontists within 10 miles were clustered mostly in the Northeast, central East Coast, Florida, West Coast, Arizona, and Midwest. Conclusions. In this study, the authors identified wide variations in geographic proximity to a practicing periodontist for adults with severe periodontitis. Practical Implications. Dental practitioners may provide preventive care and counseling for periodontitis and referrals for specialty care. Geographic proximity to specialized periodontal care may vary widely by locality. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effects of the COVID-19 pandemic on oral health care provided from July 2020 through December 2021 using national claims data. Deidentified quarterly claims from 2017 through 2021 were analyzed (2017-2019 provided prepandemic data). Data were sorted into multiple treatment categories. Analyses compared prepandemic with postpandemic procedure volumes and were stratified according to age groups (0-5 years, 6-18 years, 19-64 years, ≥ 65 years). For children aged 0 through 5 years, use of sealants and topical fluorides other than varnish were considerably lower in 2021, as were direct operative and palliative procedures from 2020 through 2021. Only use of silver diamine fluoride, prefabricated crowns, and oral surgery increased significantly (P <.05) in some quarters. For children aged 6 through 18 years, diagnostic, direct operative, periodontic, oral surgery, and palliative procedures were significantly lower in most of 2020 through 2021, and only prefabricated crowns and indirect operative procedures increased significantly in more than 3 quarters. For adults aged 19 through 64 years, diagnostic and preventive procedures were significantly lower in 3 quarters, and direct operative, gingival surgery, endodontic, and palliative procedures were significantly lower in most of 2020 through 2021. Only occlusal guards and scaling and root planing increased significantly in more than 3 quarters. For adults 65 years and older, direct operative, gingival and osseous surgery, and palliative procedures were significantly lower in more than 3 quarters; all other procedures increased significantly in more than 3 quarters. The pandemic was associated with changes in the provision of oral health care that persisted for more than 1 year. Reductions in preventive procedure volumes across age groups younger than 65 years may have implications for longer-term effects of the pandemic. [ABSTRACT FROM AUTHOR]

Research indicates a high prevalence of oral disease among Albanians. There is a lack of evidence regarding oral health beliefs and practices among Albanian immigrants in the United States and abroad. This research seeks to better understand the oral health beliefs, attitudes, and practices among Albanian immigrants living in the United States. A descriptive study was employed with a purposive sample (n = 211) of Albanian adult immigrants. A cross-sectional validated questionnaire was provided in both English and Albanian, with a response rate of 66 %. Results revealed a high use of dental services among respondents, with 68 % reported as having a dental visit and cleaning within the past year. Although 25 % of participants stated their parents and grandparents have used folk remedies, 88 % of them stated that use of folk remedies did not influence their decision to seek professional dental care. Increasing age was inversely associated with the belief in the importance of retaining natural teeth, as older respondents were less likely to agree with the prior statement; older respondents were more likely to agree with the statement 'bleeding gums are normal.' Low oral health care access and utilization was not a factor among the majority of the Albanian immigrants studied. Focusing on providing age appropriate oral health education and behavioral strategies could increase oral health knowledge and potentially improve poor oral health status among this population. [ABSTRACT FROM AUTHOR]

Older adults are retaining their teeth and need strategies for a lifetime of oral health care. Daily prevention and professional preventive care have the most significant impacts on reducing oral disease in the aging population. Providers of oral health care extend beyond traditional dental professionals to include caregivers and health care providers through teledentistry and interprofessional collaboration. Dental and aging organizations advocate for the inclusion of a dental benefit in Medicare to address access to care. Innovations in geriatric oral health care involve advances in clinical oral health care, delivery and models of care, funding, research, education, and policy., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Each year there are 800,000 myocardial infarctions in the United States. There is an increased risk of hospitalization for acute myocardial infarction (AMI) for those with periodontal disease. Yet, there is a paucity of knowledge about downstream care of AMI and how this varies with periodontal care status. The authors' aim was to examine the association between periodontal care and AMI hospitalization and 30 days after acute care. Using the MarketScan database, the authors conducted a retrospective cohort study among patients with both dental insurance and medical insurance in 2016 through 2018 who were hospitalized for AMI in 2017. There were 2,370 patients who had dental and medical coverage for 2016 through 2018 and received oral health care in 2016 through 2017 and had an AMI hospitalization in 2017. Forty-seven percent received regular or other oral health care, 7% received active periodontal care, and 10% received controlled periodontal care. More than one-third of patients (36%) did not have oral health care before the AMI hospitalization. After adjusting for patient characteristics, we found that patients in the controlled periodontal care group were significantly more likely to have visits during the 30 days after AMI hospitalization (adjusted odds ratio, 1.63; 95% CI, 1.07 to 2.47; P =.02). We found that periodontal care was associated with more after AMI visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes. Needing periodontal care is associated with more favorable outcomes related to AMI hospitalization. Early intervention to ensure stable periodontal health in patients with risk factors for AMI could reduce downstream hospital resource use. [ABSTRACT FROM AUTHOR]

There are two very different ways of understanding access and care that are at work in contemporary American society. One of these is the understanding that our society's health professions have about access and care as they consider their ethical commitment to respond to patients' oral health needs. The other is how these matters are understood within America's public culture. In this view, needs--including health care needs--are no different in kind or ethical significance from unmet desires of any sort. This article will spell out the differences between these two ways of understanding care and access. Comprehending the distance that separates the health professions' perspective from much of mainstream American thinking on these matters is essential to a careful discussion of the ethics of access to oral health care. [ABSTRACT FROM AUTHOR]

Older adults are retaining their teeth and need strategies for a lifetime of oral health care. Daily prevention and professional preventive care have the most significant impacts on reducing oral disease in the aging population. Providers of oral health care extend beyond traditional dental professionals to include caregivers and health care providers through teledentistry and interprofessional collaboration. Dental and aging organizations advocate for the inclusion of a dental benefit in Medicare to address access to care. Innovations in geriatric oral health care involve advances in clinical oral health care, delivery and models of care, funding, research, education, and policy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The integration of dentistry into comprehensive and long-term care has occurred infrequently and with limited success. The authors aim to describe how the Program of All-Inclusive Care for the Elderly (PACE) has the potential for such incorporation for the growing population of nursing home-appropriate older adults preferring to age in place., Methods: The authors used a 56-item online survey to explore aspects of oral health care within PACE, including organizational structure, availability and provision of care, preventive protocols, and provider reimbursement. The survey was distributed to all 124 programs nationally. Data analyses included descriptive statistics for each of the variables of interest., Results: Thirty-five programs completed the survey (28%) in 23 states (74%) where PACE is available. Most programs covered comprehensive dental services and predominantly provided care off-site. Most programs reimbursed dentists at Medicaid fee-for-service rates and some at commercial rates. Dentistry was most frequently ranked the second-highest specialty focus behind mental health., Conclusions: PACE is a comprehensive interdisciplinary model of care and an underused opportunity for furthering medical-dental integration. It uses local dental resources in order to accommodate the oral health care needs of the growing population of older adults preferring to age in place., Practical Implications: PACE is an opportunity for the dental profession to further medical-dental integration and ensure that newer models of long-term care include comprehensive and coordinated oral health care programs. It is also an opportunity to promote an integrated model of care with policy makers to support integrated oral health care for the nursing home-eligible population., (Copyright © 2020 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: Dentists contribute to the prevailing opioid epidemic in the United States. Concerning the population enrolled in Medicaid, little is known about dentists' opioid prescribing., Methods: The authors performed a retrospective cohort study of beneficiaries of Medicaid in Washington state with dental claims in 2014 and 2015. The primary outcome was the proportion of dental visits associated with an opioid prescription. The authors categorized visits as invasive or noninvasive by using procedure codes and each beneficiary as being at low or high risk by using his or her prescription history from the prescription drug monitoring program., Results: A total of 126,660 (10.3%) of all dental visits, most of which were invasive (66.9%), among the population enrolled in Medicaid in Washington state was associated with opioid prescriptions. However, noninvasive dental visits and visits for beneficiaries who had prior high-risk prescription use were associated with significantly higher mean days' supply and mean quantity of opioids prescribed. Results from the multivariate logistic regression showed that the probability of having an opioid-associated visit increased by 35.6 percentage points when the procedures were invasive and by 11.1 percentage points when the beneficiary had prior high-risk prescription use., Conclusions: This baseline of opioid prescribing patterns after dental visits among the population enrolled in Medicaid in Washington state in 2014 and 2015 can inform future studies in which the investigators examine the effect of policies on opioid prescribing patterns and reasons for the variability in the dosage and duration of opioid prescriptions associated with noninvasive visits., Practical Implications: Dentists must exercise caution when prescribing opioids during invasive visits and to patients with prior high-risk prescription use., (Copyright © 2019 American Dental Association. Published by Elsevier Inc. All rights reserved.)

As a consumer protection, the Affordable Care Act (ACA) requires that large-group health plans spend at least 85 percent of all premium dollars on health services and quality improvement activities-thus giving the plans a medical loss ratio (MLR) of 85 percent. Small-group and individual plans must have an MLR of at least 80 percent. The ACA did not set minimum MLRs for dental plans. California passed a law in 2014 requiring dental plans to report MLRs but stopped short of setting minimum thresholds. We analyzed dental plans' MLRs reported in California for 2014 and 2015. The average MLR, weighted by covered lives, was 76 percent, with wide variation across product types and sizes. Few products sold by dental plans met the MLR thresholds set by the ACA, but many did meet or exceed other proposed thresholds. While millions of Californians were in large-group plans that achieved high MLRs, millions more were in other plans with relatively low MLRs. A legislatively mandated MLR would provide a standardized financial tool and potentially ensure value for dental insurance products. Given the multiplicity of dental products and the varying numbers of covered lives in those products, setting MLR thresholds poses a challenge for stakeholders.

Oral health care is a necessary and critical component of health care for pregnant women, but its importance is often overlooked by clinicians. Pregnant women who are low-income also find it particularly difficult to access care. This analytic essay summarizes oral health coverage for pregnant women under various types of health insurance coverage, including Medicaid, the Children's Health Insurance Program, and coverage options available under the Affordable Care Act. We hope this information will help clinicians better understand the importance of oral health care during pregnancy and the range of coverage options that may be available to their patients.

Healthy tooth development starts early in life, beginning even before birth. We present new evidence suggesting that a historic public health insurance expansion for pregnant women and children in the United States in the 1980s and 1990s may have had long-lasting effects on the oral health of the children gaining eligibility. We estimated the relationship between adult oral health and the extent of state public health insurance eligibility for pregnant women, infants, and children throughout childhood separately for non-Hispanic whites, non-Hispanic blacks, and Hispanics. We found that expanded Medicaid coverage geared toward pregnant women and children during their first year of life was linked to better oral health in adulthood among non-Hispanic blacks. Our results also suggested that there might be a benefit to expanded public health insurance eligibility for children at ages 1-6 among non-Hispanic blacks and Hispanics. Medicaid expansions appear to have had long-lasting effects for certain low-income children and helped narrow racial/ethnic disparities in adult oral health., (Project HOPE—The People-to-People Health Foundation, Inc.)