Session
Timely Topics in Dental Public Health
APHA 2022 Annual Meeting and Expo
Abstract
Impact of COVID-19 on oral health status in K-8 students in Tuolumne County
APHA 2022 Annual Meeting and Expo
Background: The COVID-19 pandemic presented many challenges for K-8 students. The transition to virtual formats meant services typically offered in schools were unavailable. In rural communities, where students already face barriers accessing services like health and dental services, the transition meant that many students went without preventative screenings performed in school settings. Many students in Tuolumne County, especially those in the most rural areas of the county, had limited options for dental services. As a result, it was expected that there would be an increase in the prevalence and urgency level of active dental caries in Tuolumne County students.
Method/Procedure: In 2019 the Oral Health program partnered with California’s Office of Oral Health to pilot a decayed, missing, sealed, filled (DMFS) form for school-based screenings in K-8 students at three of Tuolumne County’s most high need schools. Following school reopenings in 2021, screenings were resumed at the same three schools.
Results: In 2019, a total of 415 K-8 students were screened with 43% having active caries and .24% needing urgent care. In the Fall of 2021, 379 students were screened with 41% having active caries and 5% in need of urgent care, a significant increase compared to screenings prior to the pandemic.
Discussion/Implications for Practice: The COVID pandemic has impacted the health status of many students, including their oral health. The increased rate of students requiring urgent dental care highlights the importance of continued oral health services and education in school settings following the pandemic.
Abstract
Application of the Health Belief Model to preventive dental behaviors among college students
APHA 2022 Annual Meeting and Expo
Periodontitis and dental caries are two significant oral diseases that impact 47 and 28 percent of U.S. adults, respectively. Individuals' beliefs about oral diseases can influence their preventive dental behaviors such as tooth brushing, flossing, and regular dental checkups. The Health Belief Model (HBM) has been frequently utilized in behavioral studies to better understand health behaviors, and it can be applied to assess students’ preventive dental behaviors. PURPOSE: To evaluate college students' preventive dental behaviors based on HBM and to identify key constructs of HBM to promote preventive dental behaviors. METHODS: This study enlisted the participation of 550 college students (ages 18 to 25; 69.8% female). An online survey was used for data collection. After adjusting demographic characteristics, a multivariate analysis of variance was used to examine the relationship between HBM constructs and protective dental behaviors. In addition, chi-square was used to determine the prevalence of preventive dental behaviors associated with dental knowledge level. RESULTS: Perceived barriers and self-efficacy were significant predictors of preventive dental behaviors among college students (p<0.001). Also, a significantly higher proportion of students with sufficient dental knowledge met the recommendations for tooth brushing and regular dental checkups compared to those with deficient and moderate dental knowledge (p<0.05). CONCLUSION: The Health Belief Model could be an effective framework to promote preventive dental behaviors for college students, particularly, using perceived barriers and self-efficacy. In addition, increasing dental knowledge could be an effective strategy to promote preventive dental behaviors among college students.
Abstract
Examining First Wave Experiences of Early-Career US Dentists During the COVID-19 Pandemic: Implications for Oral Health Policy and Practice
APHA 2022 Annual Meeting and Expo
Background. No known study to date has qualitatively described early career and new practice owners experiences as US dentists providing patient care during COVID-19 with regard to office closures, care of emergency patients, personal protective equipment changes and the short and long-term concerns for the dental profession following COVID-19. Therefore, the purpose of this study was to describe the experiences of early-career US dentists during the initial wave of the COVID-19 pandemic.
Methods. This study utilized a qualitative, semi-structured interview methodology for data collection. SPSS 26 and NVivo12 were utilized for data analysis.
Results. In April 2020, a total of 12 early career US dentists completed the interview study protocol. The study sample majority was male (67%), with a mean age of 32 (range = 30-37) and an average of 6 years of dental practice experience (range = 5-10). Participants qualitatively described their professional perspectives and dental practice experiences during the COVID-19 pandemic in phone interviews with the research team. In sum, three organizing themes emerged: 1) Dentistry During COVID-19: Experiences During the First-Wave, 2) Dentists’ Long-Term Concerns Regarding COVID-19, and 3) COVID-19 Professional Communication and Needed Dental Research.
Conclusions. The chief findings of this study are dentists’ long-term concerns for the profession post-COVID-19. Research needs remain around how to best treat patients in dental office settings during current and future global infectious disease outbreaks.
Practical Implications. It is important that we learn from the experiences of early career dentists and new practice owners during the COVID-19 pandemic to implement strategies to support the oral health of communities and ensure the safety of clinicians and their staff during future infectious disease outbreaks.
Key Words. COVID-19, dentistry, public health, interview, PPE
Abstract
When Sugar is Not So Sweet
APHA 2022 Annual Meeting and Expo
Background: Sugar-sweetened beverages (SSB) are the number one source of added sugars in American diets. In California, 2 out of 5, or about 42 percent of children consume at least one SSB per day. Consuming added sugar can increase the risk of many health issues including tooth decay.
Project Aim: The aim of this implementation project was to reduce SSB consumption using the When Sugar is Not So Sweet intervention guide within the dental care setting by implementing the 5 A’s technique of Motivational Interviewing. This model has been widely viewed as the standard in addressing public health issues such as tobacco cessation and treatment.
Methods: The Office of Oral Health, California Department of Public Health (OOH-CDPH) has collaborated with the Alaska Department of Health and Social Services to adopt and adapt the When Sugar is Not So Sweet intervention guide. The guide, developed by Alaska through a CDC grant, utilizes Motivational Interviewing techniques in the dental setting to help patients make positive behavioral choices regarding SSB consumption by prompting the provider to have meaningful discussions using the 5 A’s motivation conversation technique. For example, Asking about sugary drinks, Advising to reduce consumption of sugary drinks, Assessing readiness to make a change, Assisting with developing a plan of action, and to Arranging for follow-up and support. In addition, OOH-CDPH adapted the guide to feature images and messaging consistent with the State’s Rethink Your Drink Initiatives.
Implementation: The implementation process is three-fold. First, OOH-CDPH is disseminating the guide as a tool for dental care settings to implement SSB reduction strategies. Second, local oral health programs and Medi-Cal dental providers are being engaged through webinar trainings to implement the intervention in their programs and practices. Finally, Medicaid providers are encouraged to use the guide in providing SSB reduction counseling as a part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative that includes caries risk assessment and nutritional counseling.
Abstract
Impact of the COVID-19 pandemic on preventive dental behaviors among college students
APHA 2022 Annual Meeting and Expo
Oral health has been impacted by COVID-19 directly (leading to conditions including xerostomia, taste dysfunction, and oral mucosal lesions) and indirectly (leading to 46.7% of U.S. young adults postponing dentist appointments). Maintaining preventive dental behaviors such as tooth brushing, flossing, and dental checkups, is critical to minimizing these oral health complications, especially for college students who are at higher risk during the COVID-19 pandemic. PURPOSE: To assess the impact of the COVID-19 pandemic on preventive dental behaviors among college students. METHODS: A sample of 550 college students (age: 18-25 years; 69.8 % female) completed an online survey. Descriptive statistics were calculated for demographic and COVID-19 variables and the prevalence of preventive dental behaviors. Also, chi-square was applied to evaluate the impact of COVID-19 on college students’ preventive dental behaviors. RESULTS: 71.5% of the participants received the COVID-19 vaccine, out of which 97.7% were fully vaccinated. The majority of participants met the recommendations for teeth brushing (61.4%) and dental checkups (59.4%), but only 19.4% met the flossing recommendation. Although most of the participants (about 80~89%) claimed that the COVID-19 pandemic had no influence on their preventive dental behaviors, a considerable number still reported positive and negative influences of COVID-19 on their behaviors. CONCLUSION: College students’ preventive dental behaviors were not easily influenced by the COVID-19 pandemic, but a program for promoting preventive dental behaviors during the pandemic time would be beneficial.
Abstract
CATCH Healthy Smiles randomized controlled trial for oral health promotion in elementary school childen
APHA 2022 Annual Meeting and Expo
Dental caries is the most common childhood disease with 68% of entering kindergarten children having tooth decay. In Houston, TX, our preliminary analysis showed 54% of children in Kindergarten, 62% in grade 1 and 73% in grade 2 had caries experience. In 2020, 9 million children missed their well-child dental appointments. Furthermore, 51 million hours of school are missed each year due to dental problems. Absences matter because school districts lose millions in funding every year due to absences. Children with poor oral health are more than two times more likely to perform poorly in school and children with cavities in their baby teeth are three times more likely to get cavities in their adult teeth. The top 2 oral diseases (tooth decay and gum disease) are preventable. In response to this public health issue, the Texas 83rd legislative session added oral health as a required topic to the state education code. Schools can make a significant impact on prevention of dental caries and tooth decay in children. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st and 2nd grade. CATCH Healthy Smiles is based on Coordinated Approach to Child Health (CATCH) is an evidence-based coordinated school health Texas Education Agency-approved program, and has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children.
This presentation will cover the need to address dental caries among children using the CATCH coordinated school health model, study design, theoretical framework, conception, development, operationalization, and evaluation of the CATCH Healthy Smiles program using a rigorous study design, and discuss platform for dissemination of program components, if found to be effective. We will also discuss the partnership between UTHealth School of Public Health, Harris County Public Health Dental Health Services, and CATCH Global Foundation for CATCH Healthy Smiles, and sustainability of program components if found effective.
Abstract
Mediating Factors of Dental Hygiene Behaviors Among College Students: Application of the Theory of Planned Behavior
APHA 2022 Annual Meeting and Expo
Background: Percentage of college students meeting dental hygiene recommendations is below the national average of adults. Neglecting dental hygiene behaviors results in physical and psychological stress, social anxiety, and a lower quality of life. College presents a transitional time, where behavioral development continues from adolescence to adulthood. However, reasons for dental neglect during this time are unclear.
Purpose: To examine mediating factors, barriers and facilitators of dental hygiene behaviors among college students using the Theory of Planned Behavior.
Methods: Examination of the literature using PRISMA guidelines identified potential studies which used the Theory of Planned Behavior to assess dental hygiene behaviors of college students. Articles were reviewed using the Critical Appraisal guidelines to assess quality of each study. Examples of assessment criteria include: population size, statistical methods, internal validity. Mediating factors, barriers, and facilitators were identified.
Results: Appraisal results indicate that the quality of research regarding dental hygiene behaviors varies. Perceived behavioral control is the most common predictor of each dental hygiene behavior. Mediating factors include year in school, race, and insurance coverage. Barriers include perceived difficulty, pain, and lack of available tools. Facilitators include dental health programs, oral health knowledge, and public health outreach.
Conclusions: Varying predictors influence each dental hygiene behavior. Improving access to dental hygiene resources on campus can be used to enhance oral health. Colleges should carefully consider enhancing dental health education in the academic curriculum.
Abstract
Challenges, obstacles, and successes in developing a dual degree track within a pediatric dentistry residency
APHA 2022 Annual Meeting and Expo
PURPOSE
Professionals with dual degrees can uniquely address health inequities. However, few examples of integrated graduate training in pediatric dentistry and public health exist. We describe the implementation of a combined Master of Science-Master of Public Health (MS-MPH) degree track in a pediatric dentistry residency and review competency alignment in MPH and pediatric dentistry education.
DESIGN
The MS-MPH curriculum consolidates overlapping coursework while enhancing the applications of public health concepts. Implementation challenges included navigating tuition and fees, obtaining university and accreditation approvals, selecting trainees, and maintaining trainee wellness.
Accreditation standards and competencies for both degrees were individually reviewed and integrated into a combined pediatric population oral health educational framework called the Seven Keys to Pediatric Population Oral Health.
RESULTS
The MS-MPH track minimally extended the existing 24-month MS program to a 27-month dual degree program by utilizing credit hour overload waivers. One resident from each class is chosen and funded. The classes of 2023 and 2024 had 13 and 12 interested applicants, respectively. The MPH program tuition is reimbursed through grant funding, which required coordination between academic units as we move towards a sustainable MS-MPH model. Maintaining trainee wellness through mentorship and advising was identified as a priority. Trainees have expressed high satisfaction with the dual degree program and relevance to their current patient care activities as well as future careers.
CONCLUSIONS
This project demonstrates successful implementation of an MS-MPH program. Dual-degree programs can enhance the oral health workforce and improve oral health trajectories for children.
Abstract
“Knowing the ins and outs”: Dental students’ perceived preparedness to practice after dental practice management curriculum
APHA 2022 Annual Meeting and Expo
There is high demand for dentists in leadership roles in communities and practice. Previous studies have found that dentists report inadequate preparedness for practice management. This study aimed to assess former dental students’ perceived preparedness to practice following participation in a dental practice management curriculum.
In January 2020, former/current affiliates of the UF College of Dentistry, UF Dental Continuing Education curriculum, and UF Alumni Association were invited to complete an online survey (n=153). The survey included sociodemographic questions and items to assess preparedness to practice. Key items about preparedness were grouped into four domains (professional development, legal assistance, finance, and operations) and assessed using Likert scales (1 = not useful at all to 5 = very useful). The final sample was subset to participants that completed the 13-module curriculum (n=54). Descriptive statistics and independent sample t-tests were employed.
Most participants were aged 25-39 (56%) with 13.1 years’ experience. Majority were also practicing dentists (82%), working in private practice (65%), and conducted general/family dentistry (65%). Overall, participants found the curriculum most helpful with legal assistance (M=4.53, SD=3.65) and least helpful in finance (M=3.87, SD=3.49). Participants in non-private settings reported more preparedness in professional development (e.g., leadership, branding) versus private settings (t=-2.60, p<0.05). When asked what additional content would be useful, participants commonly discussed subjects related to finance and business operations.
Participants found the curriculum helpful in legal assistance and identified areas for improvement across other domains. Findings emphasize the adoption of a student-centered, practice management curriculum in all dental education programs.
Abstract
Getting to Yes: Consensus-led State Advocacy Effort to Advance Medicaid Dental
APHA 2022 Annual Meeting and Expo
Learning Objective: Participants will review successful advocacy approaches used by a stakeholder group leading to an unprecedented, solutions-oriented package of dental bills in the 2021 Minnesota legislative session. Key elements include a consensus process based on the Harvard Business Review article, Leading Change: Why Transformation Efforts Fail, and the use of a 3M playbook to hone dental messaging into a public value-focused white paper.
Background: In Minnesota, as across the United States, low-income and publicly insured individuals experience barriers to routine dental care. Over the past decade, rather than maintaining adequate investment, Minnesota’s public adult dental benefit set was cut in a variety of ways during budget deficits. Reimbursement rates, based on 1989 fees, had dropped to among the lowest in the nation. Without support for broad rate increases, a Critical Access Provider Program (CAPP) was established to supplement the low base rate for those dental practices agreeing to certain criteria. While successful in sustaining and even expanding a dental safety net, the number of Medicaid enrollees doubled. Paying a higher rate to CAPP providers was viewed by some as unfair. Multiple surveys/reports consistently found that low rates, high administrative burdens, and lack of transparency contributed to low dentist participation in public dental programs.
Growing evidence of the negative consequences of low utilization for routine and preventive dental services among publicly insured individuals, and even a corrective action report by CMS did not, however, result in significant administrative or legislative action. Various proposals for increased reimbursement and administrative simplification were made each year; however, disparate voices and conflicting priorities made it easy for legislators to deprioritize dental issues—until 2021.
Transformative Method: In late 2019, a diverse group of dental professionals and advocates, calling itself “Get to Yes with DHS, worked in partnership with 3M’s policy and marketing specialists to develop a white paper entitled Minnesota Leads the Nation in Dental Health Disparities: Medicaid Dental Providers Have the Answers. The culmination of nearly two years’ consensus-building meetings, with nearly two dozen organizations signed on as supporters, the white paper was key to successful passage of the legislative package. This presentation details the key components of this process that enabled effective oral health advocacy and successful reform of public dental programs.
Conclusion: The described framework provides a structured and focused process to convene diverse stakeholders to unify and amplify oral health advocacy to achieve successful policy reforms.