Catherine J. Binkley

Barriers to Care-Seeking for Children's Oral Health Among Low-Income Caregivers

OBJECTIVES We identified psychosocial, structural, and cultural barriers to seeking dental care among nonutilizing caregivers of Medicaid-enrolled children. METHODS We used Medicaid utilization records to identify utilizing and nonutilizing African American and White caregivers of Medicaid-enrolled children in Jefferson County, Kentucky. We conducted 8 focus groups (N=76) with a stratified random sample of responding caregivers; transcripts were qualitatively analyzed. RESULTS Psychosocial factors associated with utilization included oral health beliefs, norms of caregiver responsibility, and positive caregiver dental experiences. Utilizing groups reported higher education; health beliefs included identifying oral health with overall health and professional preventive dental care with caregiver responsibility for childrens overall health. These beliefs may mediate shared structural barriers, including transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid. Expectation of poor oral health among some low-income caregivers was among factors identified with nonutilization. CONCLUSIONS Disadvantaged caregivers reported multiple barriers to accessing dental care for their children. Providers, Medicaid administrators, and schools must coordinate steps to encourage caregiver-controlled dental care, build trust, and link professional preventive dental care with caregiver responsibility for childrens overall health.

A practical approach to full mouth rehabilitation

The concepts of traditional full mouth reconstruction have been reviewed. A practical full mouth rehabilitation technique has been described combining the chairside advantages of the programmed quadrant reconstruction with the laboratory advantages associated with the complete mouth simultaneous rehabilitation.

Reinforced heat-processed acrylic resin provisional restorations

A technique has been described for the fabrication of strong, esthetic, and periodontally considerable provisional restorations. The technique involves cast nonprecious metal frameworks and heat-processed acrylic resin.

Improving the oral health of residents with intellectual and developmental disabilities: An oral health strategy and pilot study

This article presents an oral health (OH) strategy and pilot study focusing on individuals with intellectual and/or developmental disabilities (IDD) living in group homes. The strategy consists of four components: (1) planned action in the form of the behavioral contract and caregiver OH action planning; (2) capacity building through didactic and observation learning training; (3) environmental adaptations consisting of additional oral heath devices and strategies to create a calm atmosphere; and (4) reinforcement by post-training coaching. A pilot study was conducted consisting of pre- and post-assessment data collected 1 week before and 1 week after implementing a 1-month OH strategy. The study sample comprised 11 group homes with 21 caregivers and 25 residents with IDD from one service organization in a Midwestern city. A process evaluation found high-quality implementation of the OH strategy as measured by dosage, fidelity, and caregiver reactions to implementing the strategy. Using repeated cross-sectional and repeated measures analyses, we found statistically significant positive changes in OH status and oral hygiene practices of residents. Caregiver self-efficacy as a mechanism of change was not adequately evaluated; however, positive change was found in some but not all types of caregiver OH support that were assessed. Lessons learned from implementing the pilot study intervention and evaluation are discussed, as are the next steps in conducting an efficacy study of the OH strategy.

Modest reduction in risk for ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation following topical oral chlorhexidine.

Article Title and Bibliographic Information Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Am J Crit Care 2009;18:428-37. Reviewers Frank A. Scannapieco, DMD, PhD, Catherine J. Binkley, DDS, MSPH, PhD Purpose/Question Does mechanical (toothbrushing), topical oral chlorhexidine, and/or a combination of toothbrushing plus chlorhexidine reduce the risk of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation? Source of Funding National Institutes of Health Grant R01 NR07652 Type of Study/Design Randomized controlled trial Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

Childhood caries in the state of Kentucky, USA: a cross-sectional study

BackgroundUntreated dental caries afflicts almost one third of school-aged children in the United States and many of them are from disadvantaged families. This cross-sectional study was undertaken to investigate the prevalence of untreated caries in north central Kentucky, USA and to examine the relationships between the available demographic variables and untreated childhood caries as reported on the forms from the Smile Kentucky! program.MethodsDuring the fall of 2008, caries status was assessed during the visual oral screening examination component of “SmileKentucky!”– a model of the American Dental Association’s Give Kids A Smile program. Parents had completed brief surveys concerning 3,488 elementary school children aged 5 to 13 years who participated in the program. A secondary analysis was conducted using univariate, bivariate and multivariate statistical methods.ResultsUntreated caries was reported in 33% of children. Bivariate and logistic regression analyses found that the most significant risk factors for having untreated caries were living in the metropolitan Louisville, Kentucky area, not having had a dental visit in the previous 3 years and not having any form of dental insurance.ConclusionsUntreated caries in elementary school children is prevalent in north-central Kentucky despite efforts to improve access to care. The results suggest that additional family and community preventive initiatives are needed to reduce the development of childhood caries in this area of the United States.

Increasing dental care utilization by Medicaid‐eligible children: a dental care coordinator intervention

OBJECTIVES The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group. METHODS One hundred and thirty-six children enrolled in Medicaid aged 4 to 15 years at baseline in 2004 who had not had Medicaid claims for 2 years, were randomly assigned to intervention or control groups for 12 months. Children and caregivers in the intervention group received education, assistance in finding a dentist if the child did not have one, and assistance and support in scheduling and keeping dental appointments. All children continued to receive routine member services from the dental plan administrator, including newsletters and benefit updates during the study. RESULTS Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail. CONCLUSION The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Porcelain-fused-to-metal crowns as replacements for denture teeth in removable partial denture construction.

A procedure has been described for using porcelain-fused-to-metal crowns in place of denture teeth on a removable partial denture. Improved esthetic results are achieved when replacement denture teeth are made simultaneously with, and visually match, adjacent tooth crowns. This procedure provides a superior treatment result, particularly where multiple unilateral anterior teeth are lost and a removable partial denture is indicated.