Abstract
Evidence-Based Recommendations for Silver Diamine Fluoride and Fluoride Varnish treatments in Community Programs
Jaana Gold, DDS, MPH, PhD, CPH
University of Florida College of Dentistry, Gainesville, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Untreated caries disease, lack of insurance and poor access to care are major public health problems for low-income populations in US. The use of professionally applied topical fluoride varnish (FV) is popular preventive treatment approach in community programs to prevent and remineralize caries lesions in children. A new addition to professional fluoride treatments is 38% Silver diamine fluoride (SDF), which by providing both antimicrobial and remineralizing activity, may offer a non-invasive and easy method to arrest dentinal caries lesions in young children and in populations with limited access to care.
The goal of this session is to compare 5% FV and 38% SDF in preventing and arresting caries lesions and present the latest evidence and mechanism of action of SDF. The speaker will also present evidence-based clinical recommendations for SDF and FV treatments.
Chronic disease management and prevention
Abstract
A comparative 2x2 crossover clinical study on the effectiveness of two dental gels on dental plaque
Anuradha Nayudu, BDS, MPH - student.
University Of California, Irvine, Irvine, CA 92697-3957, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Aims: A prospective, randomized controlled, double-blinded, cross over study was conducted to compare the dental plaque control effectiveness of an activated Edathamil test gel to that of a Triclosan/copolymer fluoride positive control dentifrice.
Materials and Methods: Twenty-two subjects with moderate gingivitis were randomly assigned to brush twice daily with a test or control gel. After professional coronal polishing, dental plaque was measured by the Quigley Hein (Turesky Modification) Plaque Index on a scale of 0-5 at Baseline, 2 weeks and 4 weeks. After a 20-day washout period and repeated professional coronal polishing, subjects then brushed with the second dental gel. The Plaque Index was again recorded at Baseline, week 2 and week 4. The effects of each dental gel on dental plaque control were compared using the t-test.
Results: Use of the activated Edathamil test gel resulted in statistically significantly lower levels of plaque versus the Triclosan/copolymer test dentifrice at each time point. Forty-five percent less plaque was measured after test agent use than after control agent brushing over 4 weeks(p<0.000000005).
Conclusion: The activated Edathamil dental gel formulation provided effective plaque control and reduced gingival inflammation compared to a Triclosan/Co-polymer dental gel.
Clinical Relevance: The activated Edathamil formulation may be an effective tool for plaque removal and the maintenance of good gingival health particularly in patients with increased risk of periodontal disease.
Chronic disease management and prevention Clinical medicine applied in public health
Abstract
Michigan Assessment of Blood Pressure and Diabetes Screening Practices among Oral Health Professionals
Christine Farrell, RDH, MPA1, Nana Ama Erzuah, MPH2, Dawn Crane, MS, RN, ACNS-BC, CDE, DSMT1, Susan Deming, RDH, RDA, BS1, Jed Jacobson, DDS, MS, MPH3 and Teri Scorcia-Wilson, Ph.D., M.P.H.4
(1)Michigan Department of Health and Human Services, Lansing, MI, (2)Michigan Department of Health and Human Services, Laninsg, MI, (3)Delta Dental of Michigan, Ohio, Indiana, North Carolina, Okemos, MI, (4)Michigan Department of Community Health, Lansing
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
An estimated 70 million US adults have high blood pressure (HBP) and over 29 million (9.3%) of the US population have diabetes. It was also reported in 2013, 61.7% of adults ages 18-64 and 60.6% adults over ages 65 in the United States had a dental visit. Dental visits can provide an opportunity to improve both oral health and general health. This presentation will illustrate the findings and recommendations of an assessment being conducted by the Michigan Department of Health and Human Services in collaboration with Delta Dental of Michigan. Including HBP and diabetes screening as part of routine dental care can increase the role of dental professionals in managing their client's oral as well as general health care needs. The survey will be implemented among dentists, dental hygienists and dental assistants in approximately 5,000 practices across Michigan. The survey is will assess the knowledge of oral health professionals to facilitate referrals for diagnosis and care of HBP and diabetes, quantify the referrals made and determine if oral health professionals follow up with clients after referrals are made. The survey results will be collected and analyzed by the end of April 2016. The results will assist in the development of pilots, interventions and sharing of best practices to increase the number of Michigan residents screened and referred to primary care providers by oral health professionals for HBP and diabetes.
Chronic disease management and prevention
Abstract
Effect of a clinician checklist on quality improvement and safety in a dental school setting
Siddardha Chandrupatla
Harvard School of Dental Medicine, Boston, MA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background/Objective- Checklists have been widely deployed in aviation and medicine to reduce errors, improve the quality, reliability and use of best practices. In this study, the authors implemented an intelligent e-checklist within a school's EHR with the objective to improve the quality of clinical documentation.
Methods- The checklist consisted of five (medical history, smoking history, alcohol history, oral cancer screening and diagnosis) items developed through a Delphi process. We conducted pre-checklist and post-checklist chart audits of 250 randomly selected patient charts. Two reviewers reviewed the patient charts and gave a score of 0 (absent), 1 (present in the wrong EHR location) or 2 (present and correctly documented) for each clinical item.
Results- There was an overall improvement in documentation of the five checklist items. This improvement in level of completeness of clinical documentation ranged from 45% to 258% for the checklist items. There was no improvement observed in the non-checklist items.
Conclusion- Our results demonstrate the effectiveness of implementing a checklist within the EHR in order to improve adherence to best practice standards and support quality improvement initiatives.
Occupational health and safety Planning of health education strategies, interventions, and programs
Abstract
Trends in Opioid Analgesics Prescribed for Dental Care in the U.S
Jonathan Hanna, B.S.1, Cheng Zheng, PhD2, Cory Steinmetz, BS2, Elaye Okunseri, MBA, MSHR1, Aniko Szabo, PhD3 and Christopher Okunseri, BDS, MSc, MLS, FFDRCSI4
(1)Marquette University, Milwaukee, WI, (2)University Wisconsin Milwaukee, Milwaukee, WI, (3)Medical College of Wisconsin, Milwaukee, WI, (4)Marquette University School of Dentistry, Milwaukee, WI
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objective: This study examined trends in opioid analgesics prescribed for dental care and the associated sociodemographic factors and different dental procedures.
Methods: The Medical Expenditure Panel Survey (1996-2013) data was analyzed. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to estimate the overall trend during the period with and without adjustment for procedures and personal characteristics. Survey weights were incorporated to handle the sampling design. Results: The percentage of prescription opioids analgesics increased from 23.6% (1996-2003) to 28.7% (2004-2013). On average there was a 2.3% (95% CI: 1.5%-3.0%) increase per year in the odds of receiving an opioid analgesic prescription for dental care. The odds per year of opioid analgesics prescribed increased to 3.4% (95% CI: 2.6%-4.2%) after adjusting for sociodemographic factors and source of payment. In addition, those odds changed to 2.5% (95% CI: 1.8%-3.2%) after adjusting for the different dental procedures. Compared to privately insured subjects, Medicaid enrollees had higher odds of receiving a prescription for opioid analgesics. The odds of receiving a prescription for opioid analgesics was 2- 3 times higher in subjects that reported receiving surgical and root canal therapy compared to those who reported receiving diagnostic procedures.
Conclusions: The study demonstrates an increase in opioid analgesic pain medication prescribed in dental care over time. Subjects that reported receipt of surgical and root canal treatments had higher odds of reporting receipt of opioid analgesics over time.
Clinical medicine applied in public health
Abstract
Quantifying Differences between Variation in Cost and Utilization for Medicaid-Enrolled Children across Fourteen States and Three Years
Nicoleta Serban, PhD1, Paul Griffin, PhD1, Ilbin Lee, PhD1, Sean Monahan1 and Scott L. Tomar, DMD, DrPH2
(1)Georgia Institute of Technology, Atlanta, GA, (2)University of Florida College of Dentistry, Gainesville, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
BACKGROUND: Despite strong evidence for the relevance of primary care in improving health outcomes, there is not a consensus on whether the cost of prevention leads to savings in downstream healthcare costs. Population analyses with patient stratification by health risks, different demand of care and different access will help better understand and manage the impact of preventive care. Our aim is to provide utilization and cost summaries across patient strata to better inform policy makers in targeting interventions and policies.
METHODS: The study population consists of Medicaid-enrolled children across fourteen states in years 2005, 2008 and 2011. We stratify the child population by age group, defined by oral developmental stages; by clinical risk group as a proxy of expected health risk; and by urbanicity of residence zip code, controlling for different access levels. We calculate per-member-per-month cost and utilization statistics across preventive and restorative procedures from the Medicaid Analytic Extract (MAX) claims data.
RESULTS: Utilization across dental services was found to be similar across the fourteen states, however costs varied significantly within stratifications. For example, South Carolina spends up to 38% more per-member-per-month on caries in rural areas, despite only having 7.6% higher utilization than Georgia. Simultaneously, South Carolina spends 27% on high-risk beneficiaries than in Georgia.
CONCLUSIONS: Variations in cost are much larger than variation in utilization between states. Our study considers states with different reimbursement rates, health policies, and Medicaid payment systems. Controlling for the various structures of Medicaid systems informs health officials on effectiveness of different systems.
Provision of health care to the public Public health or related research
Abstract
Impact of preventive dental care on downstream healthcare utilization and cost for Medicaid-enrolled children in Georgia and South Carolina
Ilbin Lee, PhD1, Sean Monahan1, Nicoleta Serban, PhD1, Paul Griffin, PhD1 and Scott L. Tomar, DMD, DrPH2
(1)Georgia Institute of Technology, Atlanta, GA, (2)University of Florida College of Dentistry, Gainesville, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: State Medicaid programs have recently implemented interventions to promote preventive dental care among children, such as ‘Into the Mouths of Babes' of North Carolina and reimbursement rate increase of Texas. To estimate the impact of preventive care on restorative care along with the associated costs for Medicaid-enrolled children, we study patient-level longitudinal utilization over seven years.
Methods: The study population consists of the Medicaid-enrolled children in Georgia and South Carolina, enrolled for 5+ years during 2005-2011, age 3-6 years upon entry, and healthy or with minor conditions. For each child, we derive the sequence of utilization events, including preventive and restorative care, from the Medicaid Analytic Extract claims. We use machine learning techniques to cluster the patient-level utilization sequences into utilization patterns and use simulation to evaluate the impact of interventions on utilization and expenditures.
Results: We derived dominant utilization patterns of the study population, which varied significantly over the two states. In Georgia, patients that receive repeated fluorides before any caries have 44% less caries than those who do not. Among patients receiving fluoride repeatedly, those that receive sealants before any caries have 56% fewer caries as compared to those who do not. Dental examination alone does not lead to reduction in the prevalence of caries.
Conclusions: The two states exhibit different utilization behaviors. Our analysis indicates that patients receiving either repeated fluoride treatments or sealants (or both) before any caries reduces caries occurrences and the total dental care expenditures.
Biostatistics, economics Public health or related research Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
An Analysis of Oral Health Policy and Systems for Medicaid-eligible Adults in Atlanta
Rainey Ragland Sr., RDH, MPH(c), Jammie Hopkins, DrPH, MS, Elaine Archie-Booker, EdD, RN, ICPS and Brenton Powers, MPH
Morehouse School of Medicine, Atlanta, GA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Regular oral health preventive care and timely restorative treatment is crucial to maintaining overall health across the lifespan. However, significant disparities in access to oral health services exist for Medicaid adult population. This research will identify how Atlanta Medicaid-eligible adults may be disproportionately impacted by policy, access, and affordable oral health preventive services.
Methods: A review of literature and other publically available resources was conducted to assess nationally recognized oral health recommendations, Medicaid eligibility requirements, and to identify oral health providers accepting Medicaid in the city of Atlanta, GA. Medicaid-eligible population categories were assigned based on health and disability status, medical need, family size, and income level. Oral health provisions were stratified into two categories (preventive care, palliative care) and compared across each Medicaid eligible subgroup. Medicaid providers were mapped by zip code, median income, and population size. Descriptive statistics were conducted to assess provider/population density by zip code and income level.
Results: Of the 8 Georgia Medicaid-eligible categories identified, only 1 category was covered for services consistent with the national recommendations for oral health preventive care. A total of 90 Medicaid oral health providers within 17 Atlanta zip codes were identified. Medicaid providers were generally more densely concentrated in low income zip codes. However, several individual zip codes had disproportionately lower provider concentrations for their income level.
Conclusion: Georgia government should analyze and restructure their policies if they aim to effectively resolve Medicaid policy disparities, shortage of providers, and access to affordable preventive care.
Public health or related public policy
Abstract
Dentists' attitudes towards the earned benefits structure of Iowa Medicaid's Dental Wellness Plan
Aparna Ingleshwar, BDS, MPH1, Susan McKernan, DMD, MS, PhD2, Raymond Kuthy, DDS, MPH2, Julie Reynolds, DDS, MS1 and Peter Damiano, DDS, MPH3
(1)University of Iowa, College of Dentistry, Iowa City, IA, (2)University of Iowa - College of Dentistry, Public Policy Center, Iowa City, IA, (3)University of Iowa, Iowa City, IA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objective: Iowa's Dental Wellness Plan (DWP) provides coverage for the Medicaid expansion population with an earned benefits structure (EBS) that offers additional benefits upon receipt of routine recall exams. This study examines factors associated with dentists' attitudes towards this unique EBS.
Methods: All Iowa general dentists in private practice (N=1140) were surveyed in 2015. Five items assessed dentists' attitudes about the EBS and how it affects their ability to provide care. An EBS attitude score was created from these 5 items (range: -10 to 10), with higher scores indicating more positive attitudes. A linear regression model predicting EBS score was performed with explanatory variables that included: perceptions about eight common DWP-related problems, dentists' overall altruistic attitudes, and individual and practice characteristics.
Results: Adjusted survey response rate was 45% (N=489). Approximately 70% of dentists agreed that the EBS makes it difficult to provide comprehensive care and prevents patients from getting care when needed. Mean EBS score was -1.50+/-4.20, indicating slightly negative attitudes overall. In the final model (N=221), four DWP-related problems – paperwork, intermittent eligibility, limited services covered, and ability to refer to specialists – were significantly associated (p<0.05) with attitude toward EBS. Rating these issues as less problematic was associated with more positive attitudes towards EBS. Higher levels of altruism were also significantly associated with positive attitudes towards EBS.
Conclusions: General dentists' attitudes towards the EBS are influenced by their perceptions about common DWP-related problems and their personal altruistic outlook.
Conduct evaluation related to programs, research, and other areas of practice Provision of health care to the public Public health or related public policy
Abstract
Post-Referendum Fluoridation Survey of Voters in Healdsburg, California
Jannat Gill, BDS, MPH1, Howard F. Pollick, BDS, MPH2, Ann Lazar, PhD3 and Arwa Gazzaz, BDS, MPH4
(1)UCSF School of Dentistry, San Francisco, CA, (2)UCSF School of Dentistry - Division of Oral Epidemiology & Dental Public Health, San Francisco, CA, (3)University of California, San Francisco, San Francisco, CA, (4)University of British Columbia, Faculty of Dentistry, Vancouver, BC, Canada
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Although community water fluoridation (CWF) is considered one of the ten great public health achievements in the 20th century, many communities in the United States are faced with efforts to end it. One such community is Healdsburg, Sonoma County, California where the water has been fluoridated since 1952. A telephone survey of a random sample of 1000 registered voters in Healdsburg was conducted after the November 2014 referendum to understand voters' attitudes and sources of information on fluoridation. The results were compared with the referendum outcome (actual). Results from 97 completed questionnaires showed that of the 84 who stated how they voted, 79% voted in favor of CWF compared to the actual 64% (Yes 2650; No 1467) in favor. In the actual vote, 74% voted by absentee ballot compared to 72% of our sample. The mean age of registered voters for Healdsburg was 55 years compared to 64 years for our sample. The mean age of our sample in favor of CWF was 67 years compared to 55 years for those against. Of those voting against CWF, 64% said they avoided tap water, compared to 12% who voted in favor; and 57% used fluoride toothpaste, compared to 92% who voted in favor. Those who voted in our sample for CWF were 8.6 (2.3 to 31.8, p=0.001) times more likely to find the Yes campaign materials convincing than those who voted against. These study findings can be used in the event of another referendum, which is being attempted by fluoridation foes.
Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Public health or related public policy Public health or related research Social and behavioral sciences