Jane M. Chalmers

A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health‐related quality of life

UNLABELLED Aesthetic perceptions and oral health-related quality of life concerning dental fluorosis have been assessed in several studies during the past two decades. However, no comprehensive review article summarizing the studies investigating this issue has been published. OBJECTIVE To assess the relationships between perceptions of dental appearance/oral health-related quality of life (OHRQoL) and dental fluorosis. METHODS The PubMed database was searched using the Medical Subject Headings (MeSH) for English-language studies from 1985 to March 2009. Thirty-five articles qualified for inclusion and then were classified into three categories based on the type of study approach: (i) respondent review of photographs and assessment concerning satisfaction/acceptance, (ii) respondent assessment of study subjects teeth concerning satisfaction/acceptance, and (iii) respondent assessments of the psychosocial/OHRQoL impact. RESULTS There were varied results from earlier studies focused on satisfaction/acceptance of very mild to mild fluorosis. More recent studies with methodological improvements to assess impact on quality of life clearly showed that mild fluorosis was not a concern. Furthermore, mild fluorosis was sometimes associated with improved OHRQoL. Severe fluorosis was consistently reported to have negative effects on OHRQoL. CONCLUSION Because dental fluorosis in the United States and other nations without high levels of naturally-occurring fluoride is mild or very mild, with little impact on OHRQoL, dental professionals should emphasize the appropriate use of fluorides for caries prevention and preventing moderate/severe fluorosis.

Public Health Issues in Geriatric Dentistry in the United States

The aging United States population living in the new millennium has dental needs that are very different and more complex than those experienced by previous older adult cohorts during the twentieth century. The type of dental care to be provided for older Americans goes way beyond emergency care, extractions and denture care. Dental caries is still clearly a public health problem for subgroups of older Americans, such as those of lower socioeconomic status, with dementia, who are homebound and who are institutionalized. These are also the subgroups experiencing greater barriers to accessing dental care. Stakeholders, including dental professionals and the dental benefits industry, need to work together to develop innovative dental financing programs that will increase older Americans access to dental care.

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.

Oral health of Adelaide nursing home residents: longitudinal study

Objective: The Adelaide Dental Study of Nursing Homes aimed to quantify oral disease experience, incidence and increments in Adelaide nursing home residents.

Opinions on the provision of dental care in Iowa nursing homes

Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three-quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentists preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on-site at Iowa nursing homes.

Dental utilization by adult Medicaid enrollees who have indicators of intellectual and developmental disabilities (IDD).

The purpose of this study was to determine dental utilization and type of dental services for Medicaid-enrolled adults who had been identified as having intellectual and developmental disabilities (IDD). Using Iowa claims data, the authors identified adults who met any of five IDD criteria for inclusion during calendar year 2005. Service utilization rates, including use of preventive dental, routine restorative, and complex restorative services, were determined. Approximately 60% of adults with IDD had at least one dental visit in 2005. Among adults with at least one dental visit, 83% received a preventive service, 31% a routine restorative service, and 16% a complex dental service. Those age 65 and older had fewer preventive dental services than other age groups. In Iowa, dental utilization for adults 22-64 years of age with IDD was reasonably high (64%) in 2005, but individuals over age 65 had lower utilization (45%).

Dental utilization for medicaid-enrolled adults with developmental disabilities in Iowa residential care facilities

The goal of this study was to evaluate the dental utilization of Medicaid-enrolled adults in Iowa residential care facilities (n=1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid-enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.