Christopher Okunseri

Erosive Tooth Wear and Consumption of Beverages among Children in the United States

Background/Aim: Experimental studies have identified differences in the effect of physicochemical properties of beverages on the etiology of erosive tooth wear (ETW). Little is known from epidemiological studies about the relationship between ETW and consumption of juices, drinks and milk. This study examined the relationship between the consumption of juices, drinks, milk and ETW in children in the United States. Methods: The National Health and Nutrition Examinations Survey data for 2003–2004 was analyzed. Trained and calibrated examiners used the modified Smith and Knight Tooth Wear Index from a 1998 United Kingdom Adult Health Survey to measure ETW. Beverage consumption collected via a Food Frequency Questionnaire was processed with Diet*Calc software to obtain the average daily consumption frequency for all queried juice categories, milk and carbonated beverages. Survey-weighted descriptive and multivariable analyses were performed. Results: Prevalence of ETW was highest in children aged 18–19 years (56%), males (49%), and lowest in Blacks (31%). Milk and soft drinks (0.85 times a day) and fruit drinks (0.69) were the most consumed products by children. Children with ETW had significantly higher odds of being frequent consumers of apple juice after adjusting for age, gender, and race/ethnicity. Blacks had the highest mean daily apple juice consumption, but the mean difference between those with ETW and those without ETW was not significant. Conclusion: ETW was associated with frequent intake of apple juice, but the mean difference in consumption between groups with ETW versus those without ETW within racial/ethnic groups was not significant.

Prevalence of Oral Lesions and Percent CD4+ T-Lymphocytes in HIV-Infected Children on Antiretroviral Therapy

This study examined prevalence of oral lesions and how it relates to CD4 percentages in vertically infected children with HIV undergoing combination antiretroviral therapy. One hundred two HIV-infected children between the ages of 3 and 15 years attending a specialized pediatric outpatient clinic were examined for oral lesions, and their CD4 percent and viral load extracted from their medical records. Of the 102 HIV-infected children, 69% had evidence of oral pathology and 31% were disease free. The proportion with disease was: 20.6% had conventional gingivitis, 19.6% had dental caries in their primary and permanent teeth combined, 13.7% had depapillated tongue, 3.9% had early childhood caries, 2.9% had oral candidiasis, 2% had bilateral enlarged parotid gland, 1% had median rhomboid glossitis, 1% had enlarged cervical lymph nodes and 2% had other developmental abnormalities. In the group with no evidence of suppression 15% had gingival lesion, 14% tongue lesion, and 1% parotid enlargement, and in the severe suppression group 55% had gingival lesion, 45% had tongue lesion, 9% had enlarged cervical lymph nodes, and another 9% had parotid gland enlargement. The association between conventional gingivitis and low CD4 percent was statistically significant (p = 0.001). Compared to previous studies, overall prevalence estimates of oral lesions in this study was low. Children with low CD4 percent had more oral lesions, consistent with results from other HIV studies.

Medications prescribed in emergency departments for nontraumatic dental condition visits in the United States.

Background:Prior research has documented factors associated with nontraumatic dental condition (NTDC) visits to emergency departments (EDs), but little is known about the care received by patients in EDs for NTDC visits. Objective:We examined national trends in prescription of analgesics and antibiotics in EDs for NTDC visits in the United States. Research Design:We analyzed data from the National Hospital Ambulatory Medical Care survey from 1997 to 2007. We used a multivariable logistic regression model to examine factors associated with receiving analgesics and antibiotics for NTDC visits in EDs. Results:Overall 74% received at least 1 analgesic, 56% received at least 1 antibiotic, and 13% received no medication at all during NTDC visits to EDs. The prescription of medications at EDs for NTDC visits steadily increased over time for analgesics (odds ratio=1.11/y, P<0.0001) and antibiotics (odds ratio=1.06/y, P<0.0001). In the multivariable analysis, self-pay patients had significantly higher adjusted odds of receiving antibiotics, whereas those with nondental reasons for visits and children (0–4 y) had significantly lower adjusted odds of receiving a prescription for antibiotics in EDs for NTDC visits. Children (0–4 y), adults (53–72 y), and older adults (73 y and older) had lower adjusted odds (P<0.001) of receiving analgesics. Conclusions:Nationally, analgesic and antibiotic prescriptions for NTDC visits to EDs have increased substantially over time. Self-pay patients had significantly higher odds of being prescribed antibiotics. Adults over 53 years and especially those 73 years and older had significantly lower odds of receiving analgesics in EDs for NTDC visits.

Racial/Ethnic Disparities in the Acceptance of Medicaid Patients in Dental Practices

OBJECTIVES Medicaid enrollees disproportionately experience dental disease and difficulties accessing needed dental care. However, little has been documented on the factors associated with the acceptance of new Medicaid patients by dentists, and particularly whether minority dentists are more likely to accept new Medicaid patients. We therefore examined the factors associated with the acceptance of new Medicaid patients by dentists. METHODS We analyzed 2001 data from the Wisconsin Dentist Workforce Survey administered by the Wisconsin Division of Health Care Financing, Bureau of Health Information. We used descriptive statistics and logistic regression analysis to examine the factors associated with the outcome variable. RESULTS Ninety-four percent of Wisconsin licensed dentists (n = 4,301) responded to the 2001 survey. A significantly higher likelihood of accepting new Medicaid patients was found for racial/ethnic minority dentists (35 versus 19 percent of White dentists) and dentists practicing in large practices (31 versus 16 percent for those in smaller practices). In the multivariable analysis, minority dentists [odds ratio (OR) = 2.06, 95 percent confidence interval (CI) = 1.30, 3.25] and dentists in practices with >3 dentists (OR= 2.25, 95 percent CI = 1.69, 3.00) had significantly greater odds of accepting new Medicaid patients. CONCLUSIONS Racial/ethnic minority dentists are twice as likely as White dentists to accept new Medicaid patients. Dentists in larger practices also are significantly more likely than those in smaller practices to accept new Medicaid patients. These findings suggest that increasing dental workforce diversity to match the diversity of the general US population can potentially improve access to dental care for poor and minority Americans, and may serve as an important force in reducing disparities in dental care.

Increased Children's Access to Fluoride Varnish Treatment by Involving Medical Care Providers: Effect of a Medicaid Policy Change

BACKGROUND In 2004, the State of Wisconsin introduced a change to their Medicaid Policy allowing medical care providers to be reimbursed for fluoride varnish treatment provided to Medicaid enrolled children. OBJECTIVE To determine the extent by which a state-level policy change impacted access to fluoride varnish treatment (FVT) for Medicaid enrolled children. DATA SOURCE The Electronic Data Systems of Medicaid Evaluation and Decision Support database for Wisconsin from 2002 to 2006. STUDY DESIGN We analyzed Wisconsin Medicaid claims for FVT for children between the ages of 1 and 6 years, comparing rates in the prepolicy period (2002-2003) to the period (2004-2006) following the policy change. PRINCIPAL FINDINGS Medicaid claims for FVT in 2002-2003 totaled 3,631. Following the policy change, claims for FVT increased to 28,303, with 38.0 percent submitted by medical care providers. FVT rates increased for children of both sexes and all ages, rising from 1.4 per 1,000 person-years of enrollment in 2002-2003 to 6.6 per 1,000 person-years in 2004-2006. Overall, 48.6 percent of the increase in FVT was attributable to medical care providers. The largest increase was seen in children 1-2 years of age, among whom medical care providers were responsible for 83.5 percent of the increase. CONCLUSIONS A state-level Medicaid policy change was followed by both a significant involvement of medical care providers and an overall increase in FVT. Children between the ages of 1 and 2 years appear to benefit the most from the involvement of medical care providers.

Patient characteristics and trends in nontraumatic dental condition visits to emergency departments in the United States.

Objective We examined trends and patient characteristics for non-traumatic dental condition (NTDC) visits to emergency departments (EDs), and compared them to other ED visit types, specifically non-dental ambulatory care sensitive conditions (non-dental ACSCs) and non-ambulatory care sensitive conditions (non-ACSCs) in the United States. Methods We analyzed data from the National Hospital Ambulatory Medical Care survey (NHAMCS) for 1997 to 2007. We performed descriptive statistics and used a multivariate multinomial logistic regression to examine the odds of one of the three visit types occurring at an ED. All analyses were adjusted for the survey design. Results NTDC visits accounted for 1.4% of all ED visits with a 4% annual rate of increase (from 1.0% in 1997 to 1.7% in 2007). Self-pay patients (32%) and Medicaid enrollees (27%) were over-represented among NTDC visits compared to non-dental ACSC and non-ACSC visits (P < 0.0001). Females consistently accounted for over 50% of all types of ED visits examined. Compared to whites, Hispanics had significantly lower odds of an NDTC visit versus other visit types (P < 0.0001). Blacks had significantly lower odds of making NDTC visits when compared to non-dental ACSC visits only (P < 0.0001). Compared to private insurance enrollees, Medicaid and self-pay patients had 2–3 times the odds of making NTDC visits compared to other visit types. Conclusion Nationally, NTDC visits to emergency departments increased over time. Medicaid and self-pay patients had significantly higher odds of making NDTC visits.

Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid

OBJECTIVES To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED). METHODS This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist. RESULTS We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 to <50 years) and enrollees living in counties with a lower supply of dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit. CONCLUSIONS Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions.

Periodontitis and Glycemic Control in Diabetes: NHANES 2009 to 2012

BACKGROUND This study examines the association between periodontitis, diabetes (DM), and glycemic control. METHODS National Health and Nutrition Examination Survey data for 2009 to 2012 were analyzed. Periodontitis status of each participant was assessed using the full-mouth periodontal examination protocol, classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology surveillance case definition for total periodontitis. Self-reported DM status was defined as yes or no. Glycemic control was assessed using glycohemoglobin data at cutoff points of 7.0%, 7.5%, 8.0%, 8.5%, and 9.0%. Descriptive statistics and logistic regression analyses were performed, and all analyses were adjusted for the survey design. RESULTS Overall, 7,042 adults ≥30 years old with complete data were included in the study. The mean glycohemoglobin levels for individuals with and without periodontitis were 5.9% and 5.6%, respectively, and increased to 7.4% and 7.0% for participants with DM. The majority of participants with and without periodontitis were aged 50 to 64 and 35 to 49 years (37.4% versus 44.5%), respectively. In the bivariate analysis, several demographic factors were significantly associated with having periodontitis, including self-reported DM status and glycemic control. In the multivariate analysis, demographic factors, glycohemoglobin cutoff values of 8.0%, 8.5%, and 9.0%, and mean glycohemoglobin level remained significant, but self-reported DM status was not. CONCLUSION This study demonstrates that glycohemoglobin and demographic factors are significantly associated with periodontitis, but not self-reported status.

Socio-demographics of adult orthodontic visits in the United States.

INTRODUCTION Population-based studies in orthodontics have focused on differences between normative and perceived needs. However, information from national data on the prevalence of orthodontic visits and their associated factors in adults in the United States is scarce. We examined the demographic profile of likely adult users of orthodontic services and whether there is racial and ethnic disparity in orthodontic visits. METHODS We analyzed data from the Medical Expenditure Panel Survey, 2000-2004. RESULTS Overall, about 1% of the population reported an orthodontic visit. Subjects who made a general dental visit during the current year were significantly more likely to also have an orthodontic visit. Single adults, women, people between 18 and 30 years of age, and those from high-income families were more likely to report an orthodontic visit. There were no indications of racial and ethnic disparity for either black or Hispanic adults compared with white adults after adjusting for other covariates. CONCLUSIONS Substantial racial and ethnic disparity in adult orthodontic usage was not identified. Adults (ages 18-30 years), women, those with higher incomes, and single adults had significantly higher odds of reporting an orthodontic visit. However, additional studies specifically evaluating the association of treatment need among low-income families are required to evaluate whether these adults face significant barriers in accessing orthodontic care.

Self-reported oral health perceptions of Somali adults in Minnesota : a pilot study

OBJECTIVE To assess self-reported oral health perceptions and associated factors in an adult Somali population living in Minnesota, USA. METHODS We analysed data from a cross-sectional study of Somali adults aged 18 to 65+ years attending a dental school clinic for care. A comprehensive oral examination was performed by the dental school outreach team on all patients who attended a 2-week designated Somali dental clinic. Adults who consented were given an oral health questionnaire to collect information on sociodemographics, marital status, language preference and self-rated oral and general health. We performed summary statistics and differences between proportions using Fishers exact test and a comparison of means using one-way anova or a two-sample t-test. RESULTS The sample consisted of 53 adults, 75% of whom were females. About 49% of subjects reported poor/fair oral health and 38% reported poor/fair general health. Seventy-four percent rated their access to dental care as poor/fair and 83% reported that they did not have a regular source of dental care. Self-rated oral health was significantly associated with marital status (P < 0.05) and self-rated general health (P < 0.01) using Fishers exact test. CONCLUSION A substantial proportion of Somali adults rated their oral health and access to dental care as poor/fair. These findings suggest that this population would benefit from improved access to oral health care and culturally appropriate oral health education and promotion programs.