Karl Self

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.

Factors associated with reported need for dental care among people who are homeless using assistance programs

A retrospective secondary data analysis of the National Survey of Homeless Assistance Providers and Clients database was conducted to identify the demographic characteristics and correlates associated with reported need for dental care among people who are homeless in the United States. Overall, 10% of people who were homeless reported that dental care was their most needed service. Of these, 17% had a dental visit within the previous 12 months, 52% were racial/ethnic minorities, 76% lived in a central city, and 26% were veterans. The unadjusted odds for reporting a need for dental care was highest among veterans who were homeless and those whose last dental visit occurred more than 12 months ago. Compared to nonveterans who were homeless, veterans had twice the adjusted odds for reporting a need for dental care. The adjusted odds for reporting a need for dental care were lowest for those with dental insurance. Evaluation of the data suggests that dental insurance was associated with reporting lower need for dental care. Veterans who were homeless reported higher odds for dental care. Strengthening existing oral health-care programs sensitive to the needs of people who are homeless may improve their oral health and reduce their dental-disease-related morbidity.

Dental Therapy Education in Minnesota

The article discusses the development and implementation of two dental therapy educational programs in Minnesota in an effort to address oral health care disparities and improve access to oral health care in the state. Topics include the impact of dental therapy on improving oral health, improving patient experiences, and reducing the cost of dental care.

Dental school faculty attitudes toward dental therapy: A four-year follow-up

This study is a follow-up to a 2010 study at one U.S. dental school that found faculty attitudes toward the dental therapy model were mixed and there was a clear divide in attitudes between faculty members who were full-time educators and part-timers who also practiced outside the educational institution. The aim of this study was to determine faculty attitudes toward and perceptions of the dental therapy model at the same school four years after implementation of the dental therapy program. The identical questionnaire used in 2010 was used in this survey conducted from November 2013 to January 2014. All 254 full-time and part-time faculty members were invited to participate; responses were received from 75 faculty members, for a 30% response rate. Four years after the initial survey, the respondents showed greater acceptance of dental therapists and of dental therapy as a mechanism for addressing access to care problems. A majority of the respondents reported feeling a personal responsibility to ensuring the dental therapy model succeeded (52%); indicated being comfortable having a dental therapist provide care for their patients (60%); and agreed that the ability to delegate work to a dental therapist would make a dentists job more satisfying (54%). Faculty members who also worked in a private practice viewed the role of dental therapists in private practice more favorably in 2014 than in 2010. This study provides insight into how attitudes of educators toward a new profession evolve over time. The faculty appeared to be undergoing a reorientation on the topic of dental therapy. This transition in point of view may have been facilitated by factors such as continued exposure to the new professionals, information sharing, and time.