Session
Innovative Approaches in Dental Public Health Education and Practice
APHA 2022 Annual Meeting and Expo
Abstract
Association of Fluorescent Starch Nanoparticles and Caries Lesion Activity Assessment
APHA 2022 Annual Meeting and Expo
Background:
A clinical method to assess caries lesion activity (CLA) remains an unmet need in general dentistry as inactive non-cavitated carious lesions (NCCL) do not require treatment. Active NCCL should be considered for noninvasive treatment because they can progress to cavitation, requiring surgical intervention. Prior studies demonstrate that fluorescent Starch Nanoparticles (FSNP) assist in detection of NCCL. In this pre-clinical study, we evaluated the association of CLA, assessed by International Caries Detection and Assessment System (ICDAS) visual exam, with FSNP positive fluorescence.
Methods:
In this observational, cross-sectional study, 100 extracted teeth with a range of carious lesions were selected. Each tooth/lesion was categorized by dentition (primary, permanent), tooth type (molar, premolar, canine, incisor), lesion surface (occlusal, smooth, interproximal, root), ICDAS stage (1-3) and CLA status (active or inactive, per ICDAS criteria). The lesion area of interest was marked with a permanent marker. FSNP (LumiCare™ Caries Detection Rinse, GreenMark Biomedical) were applied (30sec soak, then 10sec water rinse), the tooth was airdried and area of interest was visually evaluated for presence of fluorescence by an independent, blinded evaluator using a blue light and orange filter. The association of active carious lesions and positive fluorescent illumination with FSNP application was determined using logistic regression, with adjustment for all other category variables.
Results:
Of the 100 teeth, 89% were permanent and 11% primary; 60% were molars, 16% premolars, 12% canine and 12% incisors. The lesion surface was 36% occlusal, 28% smooth, 25% proximal and 11% root. ICDAS score was 1, 2, 3 or other for 13%, 62%, 14% and 11% respectively. CLA was assessed as active in 77% and inactive in 23%. FSNP fluorescence was positive for 73%, and negative for 27% of lesions. In combination, there were: 65% active, fluorescent; 12% active, not fluorescent; 8% inactive, fluorescent; and 15% inactive, not fluorescent. Active caries lesions were 10 times more likely to have positive fluorescent illumination with FSNP application than inactive (OR 10.2, p <0.0005), when adjusted for other tooth and lesion variables.
Conclusions:
These results demonstrate a strong and significant association of FSNP positive fluorescence and caries activity assessment. This is consistent with prior results indicating FSNP penetrate enamel surface pores of active, but not remineralized lesions, resulting in fluorescent illumination due to accumulation of FSNP in the subsurface lesion. Future clinical studies are necessary to determine the predictive value of FSNP for lesion progression in vivo, which would inform treatment decisions.
Abstract
Opioid Prescribing in the United States Academic Dental Institutional Setting
APHA 2022 Annual Meeting and Expo
Background: In the United States, dentists are the leading prescribers, responsible for millions of opioid prescriptions annually. Clinically, opioids are frequently inappropriately prescribed for managing acute dental conditions, thereby contributing to the opioid crisis.
Purpose: To identify clinical and behavioral factors associated with opioid prescribing in dental academic setting in the United States.
Methods: Quantitative data analysis was performed using data from electronic dental records on 5,720,166 dental visits collected through the BigMouth data repository from 9 dental institutions between 2011-2020. Prescribing rates were calculated, trends in prescribing were assessed and statistical analysis using multi-level mixed effects logistic regression model was performed. For the qualitative analysis, 10 dentists at 1 dental institution were interviewed in 2020 and data was analyzed using thematic analysis to determine the behavioral factors that influence dentists’ opioid prescribing behaviors.
Results: The opioid prescribing rate between 2011-2020 was 2.00%, with Oral Surgeons contributing to 49% of the prescriptions. Dental visits had greater odds for opioid prescriptions when patients were between 15-24 years of age, dentists were Oral Surgeons, dental visit had at least one post-operative dental pain-associated procedure and multiple dental procedures were performed. Dentists’ prescribing behavior was determined by multiple factors and was patient-centered with dentists’ specialty, peer influence, faculty mentorship, complexity of dental procedure, contraindications to non-opioid analgesics and meeting patient expectations being the factors found to be influencers of dentists’ opioid prescribing behavior.
Conclusion: This research provided a comprehensive understanding of the factors associated with opioid prescribing by dentists.
Abstract
Hypertension Screening and Referral in the Dental Setting and Impact on Overall Health and Continuation of Care
APHA 2022 Annual Meeting and Expo
POPULATION/TOPIC: The North Dakota Department of Health Oral Health Program (ND OHP) is dedicated to improving all North Dakotans' oral health through prevention and education. Because oral health and overall health are interconnected, a greater emphasis is being placed on increasing coordination between dental and medical providers.
GOALS: The ND OHP partnered with dental providers to provide blood pressure screenings for adult patients and conduct bidirectional referrals as part of the goal to improve communication, coordination, and continuation of care. All dental offices participating in the project received training on best practices for screening patients’ blood pressures, utilizing a standardized protocol. Dental offices tracked the number of screenings provided, the number detected to have high blood pressure, the number referred to a medical practice, and the number receiving follow-up on their referral.
EQUITY/INCLUSION: North Dakota has a high number of Health Professional Shortage Areas (HPSA) within the state. These areas often include low-income, rural, and underserved populations. Due to these inequities, it was imperative through this program that partnership occurred with a wide variety of partners to serve a diverse number of individuals. Partner dental offices included Federally Qualified Health Centers, nonprofit dental clinics, Indian Health Service clinics, and private practices covering a variety of regions throughout the state.
NOTABLE RESULTS: A total of 12 dental practices with 14 office locations provided blood pressure screenings and referrals. Sixty-five dental providers were trained on blood pressure measurement and referral protocols. Dental providers conducted over 25,682 blood pressure screenings during Year 3 of the project. Dental providers detected over 3,861 high blood pressure readings, made over 492 referrals to medical providers, and received follow-up information on over 155 referrals.
CONCLUSIONS: Blood pressure screening in the dental setting has evidenced positive outcomes and increased coordination of care between dental and medical providers. Future recommendations focus on the continuation and improvement of current practices in the areas of evaluation, implementation, data collection, and sustainability to ensure inclusion and equitable access to care.
Abstract
Impact of Paid Sick Leave on Dental Services Utilization among Working Adults in the United States
APHA 2022 Annual Meeting and Expo
Background: Timely access to regular dental visits allows detection of preventable conditions in the earlier stage. Nonetheless, 37% of adults aged 18 and above had no dental visits in 2020. Various factors affect the utilization, but little is known about the influence of job characteristics.
Objectives: To examine the relationship between paid sick leave and dental care utilization among working adults in the U.S.
Methods: The study sample population included employed adults aged 18-64 in the 2019 Medical Expenditure Panel Survey (N=7,645). The three outcome variables were a binary variable of having preventive, diagnostic and treatment dental care in the past 12 months. The primary independent variable was having a paid sick leave in their job. A multivariable logistic model was used adjusting for demographics, socioeconomic status, and general health status. All analysis were adjusted for complex survey design.
Results: Seventy-two percent of working adults had paid sick leave benefits. Availability of paid sick leave was significantly associated with higher utilization of preventive dental care (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.12-1.57) and diagnostic dental care (OR 1.31, 95% CI 1.11-1.55).
Conclusion: Paid sick leave would be an effective way to increase preventive and diagnostic dental care utilization. The study provides valuable insights to medical practitioners and health policymakers who are interested in preventing significant adverse oral health outcomes and reducing additional expenses due to severe dental diseases.
Abstract
Working in teams to explore value-based care (VBC): A bi-lingual and interprofessional education (IPE)-based simulation model
APHA 2022 Annual Meeting and Expo
Background: Hunt School of Dental Medicine (Hunt SDM) is the first dental school in West Texas aiming to serve a Spanish-speaking community that has always been considered underserved. Cultural and linguistic competence and IPE are among the foundations of the school curriculum. The majority of the dental public health curriculum is taught inteprofessionally with Foster School of Medicine at Texas Tech University Health Sciences Center El Paso (TTUHSC EP). Throughout the curriculum, both dental and medical students work in interactive interprofessional (IP) teams didactically and experientially.
Methods: As a part of their IP public health-related curriculum, dental and medical students at TTUHSC EP went through a bi-lingual VBC simulation workshop. During the workshop, students were divided into IP bilingual teams where each team role-played as a specific healthcare or community agency/organization across the U.S. Mexico border. Teams communicated with each other while representing their organizations to experience the challenges of real-life interactions to establish an Accountable Care Organization (ACO) dedicated to serve Spanish-Speaking immigrants across the border area. An electronic survey was introduced to the students (n=165) to measure their understanding of the VBC and the ACOs concepts using a scale (1 to 5) before and after the simulation workshop. Using the same scale, the students reported their perceptions regarding experiencing the complexity of communicating, cooperating, and collaborating across healthcare systems and community organizations to achieve improved health and health care access. The results were summarized using descriptive statistics and analyzed using paired t-tests.
Results: With 91.5% response rate, students reported improvements in their understanding of the VBC and ACOs concepts, respectively, from before the bi-lingual IP workshop (M = 3.03 (±1.17); and M = 2.56 (±1.24)) to after the workshop (M = 3.72 (±1.05); and M = 3.60 (±1.10)). These improvements were statistically significant for both VBC and ACOs respectively t (150) = 7.25, p <0.001; and t (150) = 9.41, p <0.001. Around 75.5% of the students rated their perceptions of experiencing the complexity of communicating, cooperating, and collaborating across health systems and community organizations to achieve improved health and health care access as ≥3
Conclusions: This study introduces a promising and innovative bilingual IPE model to help build new generations of healthcare providers with linguistic competence and collaborative capacities. Introducing similar experiences early in the healthcare curricula will help students be better prepared for the challenges in the healthcare systems.