Bhavna T. Pahel

Parental perceptions of children's oral health: The Early Childhood Oral Health Impact Scale (ECOHIS)

BackgroundDental disease and treatment experience can negatively affect the oral health related quality of life (OHRQL) of preschool aged children and their caregivers. Currently no valid and reliable instrument is available to measure these negative influences in very young children. The objective of this research was to develop the Early Childhood Oral Health Impact Scale (ECOHIS) to measure the OHRQL of preschool children and their families.MethodsTwenty-two health professionals evaluated a pool of 45 items that assess the impact of oral health problems on 6-14-year-old children and their families. The health professionals identified 36 items as relevant to preschool children. Thirty parents rated the importance of these 36 items to preschool children; 13 (9 child and 4 family) items were considered important. The 13-item ECOHIS was administered to 295 parents of 5-year-old children to assess construct validity and internal consistency reliability (using Cronbachs alpha). Test-retest reliability was evaluated among another sample of parents (N = 46) using the intraclass correlation coefficient (ICC).ResultsECOHIS scores on the child and parent sections indicating worse quality of life were significantly associated with fair or poor parental ratings of their childs general and oral health, and the presence of dental disease in the child. Cronbachs alphas for the child and family sections were 0.91 and 0.95 respectively, and the ICC for test-retest reliability was 0.84.ConclusionThe ECOHIS performed well in assessing OHRQL among children and their families. Studies in other populations are needed to further establish the instruments technical properties.

Impact of Poor Oral Health on Children's School Attendance and Performance

OBJECTIVES We examined school days missed for routine dental care versus dental pain or infection to determine the relationship between childrens oral health status and school attendance and performance. METHODS We used 2008 data from the North Carolina Child Health Assessment and Monitoring Program. The study sample, weighted to reflect the states population, included 2183 schoolchildren. Variables assessed included school absences and performance, oral health status, parental education, health insurance coverage, race, and gender. RESULTS Children with poor oral health status were nearly 3 times more likely (odds ratio = 3.89; 95% confidence interval = 1.96, 7.75) than were their counterparts to miss school as a result of dental pain. Absences caused by pain were associated with poorer school performance (P < .05), but absences for routine care were not. Mediation analyses revealed that oral health status was associated with performance independent of absence for pain. CONCLUSIONS Children with poorer oral health status were more likely to experience dental pain, miss school, and perform poorly in school. These findings suggest that improving childrens oral health status may be a vehicle to enhancing their educational experience.

Effectiveness of Preventive Dental Treatments by Physicians for Young Medicaid Enrollees

OBJECTIVE: To estimate the effectiveness of a medical office–based preventive dental program (Into the Mouths of Babes [IMB]), which included fluoride varnish application, in reducing treatments related to dental caries. METHODS: We used longitudinal claims and enrollment data for all children aged 72 months or younger enrolled in North Carolina Medicaid from 2000 through 2006. Regression analyses compared subgroups of children who received up to 6 IMB visits at ages 6 to 35 months with children who received no IMB visits. Analyses were adjusted for child and area characteristics. RESULTS: Children enrolled in North Carolina Medicaid with ≥4 IMB visits experienced, on average, a 17% reduction in dental-caries–related treatments up to 6 years of age compared with children with no IMB visits. When we simulated data for initial IMB visits at 12 and 15 months of age, there was a cumulative 49% reduction in caries-related treatments at 17 months of age. The cumulative effectiveness declined because of an increase in treatments from 24 to 36 months, an increase in referrals for dental caries occurred with increasing time since fluoride application, and emergence of teeth not initially treated with fluoride. CONCLUSIONS: North Carolinas IMB program was effective in reducing caries-related treatments for children with ≥4 IMB visits. Multiple applications of fluoride at the time of primary tooth emergence seem to be most beneficial. Referrals to dentists for treatment of existing disease detected by physicians during IMB implementation limited the cumulative reductions in caries-related treatments, but also contributed to improved oral health.

Follow‐Up Preventive Dental Visits for Medicaid‐Enrolled Children in the Medical Office

OBJECTIVE To describe the frequency and determinants of follow-up preventive oral health visits at medical offices among children screened for dental disease, receiving fluoride varnish and counseling. METHODS Parents of Medicaid children enrolled in a clinical trial completed a baseline questionnaire before their childs medical visit. The providers completed patient dental encounter forms at each visit, documenting dental services, caries risk, and dental disease. Questionnaires, encounter forms, and Medicaid claims were linked to create a database with information on visits, child and caregiver characteristics, and oral health practices. Descriptive and multivariate analyses assessed associations of variables with likelihood of follow-up visits. RESULTS A total of 744 children with mean age of 15 months at enrollment had 1,415 oral health visits. Children averaged 0.9 follow-up oral health visits and 1.3 follow-up well-child visits. Fewer children had follow-up oral health visits (55 percent) than well-child visits (70 percent), but children with a baseline preventive dental visit at a younger age had more visits with shorter intervals. Caregivers reporting greater numbers of children and putting the child to bed with the bottle had more subsequent visits. Older age of child, male child, and caregiver education < or = 12 years were associated with fewer follow-up visits. CONCLUSIONS Children with preventive dental services in medical offices have similar numbers of oral health and well-child visits, with both below recommended numbers. Strategies to increase these services may need to be tied to those aimed at increasing compliance with well-child visits, taking advantage of nonwell-child visits, and implementing Medicaid policies that allow for optimal timing of visits.

Patient- and population-reported outcomes in public health dentistry: oral health-related quality of life.

At present no process is in place in the United States to comprehensively monitor the national burden of oral diseases from the perspective of oral health-related quality of life (OHRQoL), yet available evidence shows that a substantial percentage of the adult population rates their oral health poorly. This article reviews applications of OHRQoL in dental public health. The authors specifically review its use, contributions, and needed advances in: (1) monitoring the impacts of oral diseases on OHRQoL at the national level, and in public health surveillance at the state and local levels; (2) treatment outcomes research and program evaluation; and (3) clinical practice.

Multiple imputation of dental caries data using a zero-inflated Poisson regression model

UNLABELLED Excess zeros exhibited by dental caries data require special attention when multiple imputation is applied to such data. OBJECTIVE The objective of this study was to demonstrate a simple technique using a zero-inflated Poisson (ZIP) regression model, to perform multiple imputation for missing caries data. METHODS The technique is demonstrated using data (n = 24,403) from a medical office-based preventive dental program in North Carolina, where 27.2 percent of children (n = 6,637) were missing information on physician-identified count of carious teeth. We first estimate a ZIP regression model using the nonmissing caries data (n = 17,766). The coefficients from the ZIP model are then used to predict the missing caries data. RESULTS This technique results in imputed caries counts that are similar to the non-missing caries data in their distribution, especially with respect to the excess zeros in the nonmissing caries data. CONCLUSION This technique can be easily applied to impute missing dental caries data.

Agreement between structured checklists and Medicaid claims for preventive dental visits in primary care medical offices.

For program evaluation purposes, the feasibility of matching Medicaid claims with physician-completed structured checklists (encounter forms, EFs) was assessed in a pediatric office-based preventive dental program. We examined agreement on visits (weighted kappa) and predictors of a match between EFs and claims (multinomial logit model with practice-level clustering). In total, 34,171 matches occurred between 41,252 EFs and 40,909 claims, representing 82.8 per cent of EFs and 83.5 per cent of claims. Agreement on visits was 56 per cent (weighted kappa = 0.66). Pediatric practices provided the majority of visits (82.4%) and matches. Increasing age of child and residence in same county as the medical practice increased the likelihood of a match. Structured checklists can be combined with claims to better assess provision of preventive dental services in pediatric primary care. However, future research should examine strategies to improve the completion of structured checklists by primary care providers if data beyond claims are to be used for program evaluation.

A Developmental Approach to Pediatric Oral Health

Orofacial growth and development is a complex process spanning the life course. This article provides an oral health overview in the context of overall growth, physical and social development from infancy through adolescence. It reviews oral health-specific developmental milestones during childhood (0-12 years) and adolescence (≥13 years). It examines issues particular to each age category or spanning multiple ages (eg, pediatric overweight and obesity, tobacco use, and dental trauma) in relation to oral health and development. In addition, the oral microbiome and its potential role in informing personalized oral health care across the life course is discussed.