Donald L. Chi

Preventive dental utilization for Medicaid-enrolled children in Iowa identified with intellectual and/or developmental disability

OBJECTIVES To compare preventive dental utilization for children with intellectual and/or developmental disability (IDD) and those without IDD and to identify factors associated with dental utilization. METHODS We analyzed Iowa Medicaid dental claims submitted during calendar year (CY) 2005 for a cohort of children ages 3-17 who were eligible for Medicaid for at least 11 months in CY 2005 (n = 107,605). A protocol for identifying IDD children was developed by a group of dentists and physicians with clinical experience in treating children with disabilities. Utilization rates were compared for the two groups. Crude and covariate-adjusted odds ratios were estimated using conditional logistic regression modeling. RESULTS A significantly higher proportion of non-IDD children received preventive care than those identified as IDD (48.6 percent versus 46.1 percent; P < 0.001). However, the final model revealed no statistically significant difference between the two groups. Factors such as older age, not residing in a dental Health Professional Shortage Area, interaction with the medical system, and family characteristics increased ones likelihood of receiving preventive dental care. CONCLUSION Although IDD children face additional barriers to receiving dental care and may be at greater risk for dental disease, they utilize preventive dental services at the same rate as non-IDD children. Clinical and policy efforts should focus on ensuring that all Medicaid-enrolled children receive need-appropriate levels of preventive dental care.

Socioeconomic Status, Food Security, and Dental Caries in US Children: Mediation Analyses of Data From the National Health and Nutrition Examination Survey, 2007-2008

OBJECTIVES We examined associations of household socioeconomic status (SES) and food security with childrens oral health outcomes. METHODS We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. RESULTS About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship. CONCLUSIONS Interventions and policies to ensure food security may help address the US pediatric caries epidemic.

Clinical Evidence for Polyol Efficacy

Xylitol is a safe dental caries preventive when incorporated into chewing gum or confections used habitually. The goal of this paper is to identify and assess the work on xylitol and other polyols and dental caries since 2008. Xylitol is effective when used by the mother prenatally or after delivery to prevent mutans transmission and subsequent dental caries in the offspring. One new completed trial confirmed that children of mothers who used xylitol lozenges after delivery had less dental caries than a comparison group. A similar study confirmed that the use of xylitol gum by the mother either prevented or postponed MS transmission to the offspring. Xylitol use among schoolchildren delivered via a gummy bear confection reduced S. mutans levels, but a once per day use of xylitol-containing toothpaste did not. Randomized trials, with caries outcomes, assessing xylitol-containing lozenges in adults and xylitol-containing gummy bears in children will release results in the coming year. Other studies are ongoing but are not systematic and will fail to answer important questions about how xylitol, or other polyols, can address the global dental caries problem.

Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study

OBJECTIVES We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. METHODS We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregons All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. RESULTS Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated

Impact of Chronic Condition Status and Severity on Dental Utilization for Iowa Medicaid-Enrolled Children

402 (95% CI = 

Preventive Dental Service Utilization for Medicaid-Enrolled Children in New Hampshire: A Comparison of Care Provided by Pediatric Dentists and General Dentists

396,

The oral health of homeless adolescents and young adults and determinants of oral health: preliminary findings.

408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. CONCLUSIONS Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.

Exploring the potential for foreign-trained dentists to address workforce shortages and improve access to dental care for vulnerable populations in the United States: a case study from Washington State

Background:Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. Objective:To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. Research Design:Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). Subjects:Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. Measures:The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. Results:After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%–6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). Conclusions:There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.

Lip Biting in a Pediatric Dental Patient After Dental Local Anesthesia: A Case Report

In this study, we compared preventive dental utilization through visits to a pediatric dentist (PD) vs. visits to a general dentist (GD) among Medicaid-enrolled children in New Hampshire (n = 12,964). Dental claims were analyzed using conditional logistic regression models. After adjusting for covariates, children seen by a PD were 51% more likely to have received fluoride treatment, 26% more likely to have had at least two dental examinations, and 19% more likely to have received a sealant than children seen by a GD. Overall, our results suggest that children seen by a PD were more likely to have received preventive services than those seen by a GD. Because Medicaid-enrolled children are at increased risk for poor oral health, policies should be enacted to ensure that high-risk children receive appropriate and regular prevention-oriented dental care.

Cost-Effectiveness of Pit-and-Fissure Sealants on Primary Molars in Medicaid-Enrolled Children

A survey was administered to 55 homeless adolescents and young adults aged 14 to 28 years who presented for care at a community health center in Seattle, Washington in 2005. Forty-five valid surveys were analyzed. The aim of the study was to identify factors associated with self-reported oral health. The most common self-reported dental problem was sensitive teeth (52.6%), followed by discolored teeth (48.6%), toothache (38.5%), or a broken tooth (37.8%). Dental problems were associated with lower self-reported oral health, while non-high school graduates, mixed race youths, and methamphetamine users had significantly higher self-reported oral health. Among homeless youths, addressing dental problems with direct dental care may improve self-perceived oral health. The relationships between methamphetamine use and education level, on the one hand, and self-reported oral health, on the other, are complex and may be modified by age.