Daniel D. Skaar

Dental service trends for older U.S. adults, 1998-2006

This study of the Medicare Current Beneficiary Survey (MCBS) updates trends in utilization of dental services between 1998 and 2006 for community-dwelling U.S. adults of age 65 years and older. Bivariate comparisons were made between dependent variables (annual dental visits and types of dental procedures) and independent variables (age, gender, race, income, education, population density, marital status, U.S. Census Bureau regions, and self-reported health). The estimated percentage of community-dwelling Medicare beneficiaries with a dental visit for the years studied increased from 45.0% in 1998 to 46.3% in 2006. The age group of respondents who were 85 years and older had the greatest percentage increase in dental visits. Those reporting visits with preventive procedures increased from 87.8% to 91.2% whereas those reporting visits with nonpreventive procedures declined from 63.9% to 58.4%. The prevalence of dental visits continues to trend upward for this population of older adults. Increasing delivery of preventive services will likely impact the future mix of dental services as U.S. adults live longer.

Use of the Beers criteria to identify potentially inappropriate drug use by community-dwelling older dental patients

OBJECTIVE Recognizing drugs with serious adverse experience (AE) potential in an aging population would assist practitioners in preventing drug safety issues. This study identifies drugs with potential for causing serious AEs, describes the AEs, and estimates prevalent use among older adults visiting the dentist. STUDY DESIGN Drugs with serious AE risk for older adults were identified with the use of the Beers criteria. Analyses of older adults visiting the dentist using the Medicare Current Beneficiary Survey tested associations between demographic and health-related variables and use of these drugs. Potentially serious drug-related AEs are described. RESULTS More than 3 in 10 older adults visiting the dentist were prescribed a Beers-criteria drug. Commonly prescribed Beers-criteria drugs used in dentistry include benzodiazepines and long-acting nonsteroidal antiinflammatory analgesics. CONCLUSIONS Awareness of potentially harmful drug-related AEs, their clinical consequences, and prescribing frequency for older adults will assist dentists in clinically managing patients and avoiding inappropriate prescribing.

Potentially serious drug-drug interactions among community-dwelling older adult dental patients

OBJECTIVES Reducing adverse drug events, including those resulting from drug-drug interactions, will be a health safety issue of increasing importance for dental practitioners in the coming decades as greater numbers of older adults seek oral health care. The purpose of this study was to identify prescription drugs with the potential for serious interactions and estimate prevalent use among older adults visiting the dentist. STUDY DESIGN The Medicare Current Beneficiary Survey is an ongoing series of nationally representative surveys of Medicare beneficiaries. Potentially serious drug interactions were selected with the use of published work by Partnership to Prevent Drug-Drug Interactions. Drug interactions were identified and prevalence estimates made for community-dwelling older adults visiting the dentist. Analyses were completed to test associations between sociodemographic and health-related variables and the use of prescription drugs with the potential for serious interactions. RESULTS Overall, 3.4% of those visiting the dentist were estimated to have been prescribed drugs with the potential for a serious drug interaction. Drugs commonly prescribed in dentistry with the potential for serious interactions include the benzodiazepines, macrolide antibiotics, and nonsteroidal antiinflammatory analgesics. CONCLUSIONS Understanding potentially harmful drug combinations, their clinical consequences, and the frequency with which implicated drugs are being prescribed will assist practitioners in clinically managing patients and avoiding inappropriate prescribing.

Using the Beers criteria to identify potentially inappropriate medication use by older adult dental patients

BACKGROUND An aging population indicates that increasing numbers of older adults will seek oral health care and have multiple chronic conditions treated with a number of medications. The authors examined the Medicare Current Beneficiary Survey administrative data set to characterize potentially inappropriate medication (PIM) use by older adults visiting the dentist and related adverse experiences that may affect oral health care. METHODS The authors used the 2015 Beers criteria to identify PIMs for older adults. The authors examined the Medicare Current Beneficiary Survey administrative data set for community-dwelling older adults with dental care visits and reported national prevalence estimates of Beers criteria medication prescribing. The authors used logistic regression to identify sociodemographic and health-related characteristics associated with potentially inappropriate prescribing. The authors described medication-related adverse experiences affecting dental care. RESULTS Among older adults with dental care visits, 56.9% received a prescription for at least 1 Beers criteria medication, and 28.3% received a prescription for 2 or more Beers criteria medications. Beers criteria medication use was associated most strongly with the number of comorbid diseases as represented by higher Charlson Index scores (odds ratios, > 1.0). CONCLUSIONS A substantial proportion of community-dwelling older adults visiting dentists had received prescriptions for 1 or more potentially age-inappropriate Beers criteria medications. Many of these medications have adverse effects that could affect patient safety and oral health care. PRACTICAL IMPLICATIONS These results support the need for clinicians to be aware of PIM use by older adults, recognize associated medication-related adverse events, and avoid prescribing age-inappropriate medications to this vulnerable patient population.

Is Antibiotic Prophylaxis Cost-effective for Dental Patients Following Total Knee Arthroplasty?

Introduction: Routine antibiotic prophylaxis (AP) to prevent prosthetic joint infection remains controversial. The lack of prophylaxis guideline consensus from the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) contributes to clinician confusion. Objectives: This cost-effectiveness decision model informs the AP debate and guideline development by comparing the benefits, harms, and costs of alternative prophylaxis strategies. Methods: A Markov state-transition model was developed comparing lifetime health outcomes and costs of alternative AP strategies for dental patients aged 65 y with a history of total knee arthroplasty (TKA). Based on our interpretation of AP recommendations from the AAOS and ADA, incremental cost-effectiveness ratios were calculated to compare the following strategies: no AP, AP for the first 2 y after a TKA, and lifetime AP. Results: The no-AP strategy had the lowest average lifetime costs (

Dental procedures and subsequent prosthetic joint infections: Findings from the Medicare Current Beneficiary Survey

17,119) and quality-adjusted life years (11.2151). Compared with a no-prophylaxis strategy, the 2-y AP strategy had incremental costs of

A follow-up case report of Actinobacillus actinomycetemcomitans in human periodontal disease.

56 and 0.0006 QALYs gained and was cost-effective (incremental cost-effectiveness ratio =

Demographic factors associated with dental utilization among community dwelling elderly in the United States, 1997.

95,100) when a willingness-to-pay threshold of

Original ContributionsAntibiotic ProphylaxisCost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty

100,000 per quality-adjusted life year was used. Based on the results of 1-way sensitivity analysis, the no-AP strategy was cost-effective when we modestly increased base case amoxicillin adverse event estimates that were substantially lower than estimates reported in previous models. When plausible combinations of important model parameters were varied, model results suggested that there may be clinical scenarios when AP may be appropriate for some medically at-risk patient populations. Conclusion: The results of cost-effectiveness decision modeling generally support questioning routine AP for dental patients with TKA. Sensitivity analyses suggest that prophylaxis may be cost-effective for patient populations with a higher medical risk of infection. This finding is consistent with the recommendations of the 2015 ADA practice guideline and the appropriate use criteria jointly developed by the AAOS and the ADA. Knowledge Transfer Statement: The results of this decision modeling research support the contention that routine AP before invasive dental procedures to prevent prosthetic joint infection may not be cost-effective for patients without medical conditions, potentially conferring a higher infection risk. Model sensitivity analyses suggest that there may be clinical situations when medically at-risk patients benefit from AP.