Oscar Arevalo

Trends in paediatric dental caries by poverty status in the United States, 1988–1994 and 1999–2004

BACKGROUND Recent reports have suggested that dental caries among some young children is increasing in the United States. AIM To describe changes in paediatric caries prevalence by poverty status in the United States. DESIGN National Health and Nutrition Examination Survey (NHANES) data for children aged 2-11 years for 1988-1994 and 1999-2004 were used. RESULTS Caries in the primary dentition increased among poor and non-poor boys aged 2-8 years (45-53% and 23-31%, respectively) and among non-poor boys aged 2-5 years (13-21%) from 1988-1994 to 1999-2004. Caries experience also increased on buccal-lingual, mesio-distal, and occlusal primary dental surfaces among poor children aged 2-8 years and this increase may be attributed to an increase in the number of dental surfaces restored. In the mixed dentition, caries remains relatively unchanged. Caries continues to decline in the permanent dentition for many children, but is increasing among poor non-Hispanic whites aged 6-8 years (8-22%) and poor Mexican-Americans aged 9-11 years (38-55%). CONCLUSIONS For many older children, caries continues to decline or remain unchanged. Nevertheless, for a subgroup of younger children, caries is increasing and this increase is impacting some traditionally low-risk groups of children.

How Dental Care Can Preserve and Improve Oral Health

Oral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the populations oral health literacy.

Mobile dental units: leasing or buying? A dollar‐cost analysis

INTRODUCTION The decision to acquire a mobile dental unit is based on a standard capital budgeting analysis. The next step is to determine whether to obtain the use of the mobile dental unit by borrowing and purchasing or by leasing. As a financing mechanism, leases are simply another way of borrowing money to pay for the asset. OBJECTIVE To compare lease vs. debt as financial vehicles to acquiring a mobile dental unit. METHODS An estimate for a new mobile unit was obtained. Lease and loan proposals from financial lenders were collected. A cost of capital rate was chosen for comparison. Cash flows associated with borrowing and leasing vs. buying were determined fortwo different scenarios: for profit (FP) vs. not-for-profit (NFP), at 5 years. A dollar-cost analysis was utilized to determine the option with the lowest capitalized value. RESULTS There was a net advantage to buying vs. leasing for both for FP and NFP organizations. Due to tax advantages, owning and leasing were substantially less expensive for FP than for NFP. Slight decreases in the monthly lease payments would make leasing competitive to the buying approach. CONCLUSION Exploring alternative financing vehicles may allow dental programs to expand their services through the acquisition of a mobile unit. Though programs generally own assets, it is the use of the asset which is important rather than the ownership. Dental programs can find leasing an attractive alternative by offering access to capital with cash-flow advantages.

Mobile dental operations: capital budgeting and long-term viability.

OBJECTIVE The University of Kentucky College of Dentistry (UKCD) runs a large mobile dental operation. Economic conditions dictate that as the mobile units age it will be harder to find donors willing or able to provide the financial resources for asset replacement. In order to maintain current levels of access for the underserved, consideration of replacement is paramount. A financial analysis for a new mobile unit was conducted to determine self-sustainability, return on investment (ROI), and feasibility of generating a cash reserve for its replacement in 12 years. METHODS Information on clinical income, operational and replacement costs, and capital costs was collected. A capital budgeting analysis (CBA) was conducted using the Net Present Value (NPV) methodology in four different scenarios. Depreciation funding was calculated by transferring funds from cash inflows and reinvested to offset depreciation at fixed compound interest. RESULTS A positive ROI was obtained for two scenarios. He depreciation fund did not generate a cash reserve sufficient to replace the mobile unit. CONCLUSIONS Mobile dental programs can play a vital role in providing access to care to underserved populations and ensuring their mission requires long-term planning. Careful financial viability and CBA based on sound assumptions are excellent decision-making tools.

Understanding Measurement of Dental Diseases and Research Participation in Practice Set-Up

A general understanding of the measurement of dental diseases can help practitioners in the process of assessing the patients future risk of disease. More importantly, as clinical studies shift from the traditional academic setting to practice-based networks, practitioners might play a more significant role in research. An important issue in oral health disease management in the future will be the standardization of clinical criteria and the development of alternative mechanisms of data collection for epidemiologic purposes.

Passive Observer Instruction on Parental Satisfaction in a Dental Setting

PURPOSE To assess the effect of a single pre-operative instruction given to parents to be a passive observer on satisfaction with their childs dental visit. STUDY DESIGN Parents of 105 healthy three to nine year-old patients presenting for their first restorative appointment were randomly assigned to the test or control group. The former received an oral instruction at the beginning of the appointment from the treating dentist to be a passive observer while the latter received a mock instruction. The dentist assessed whether the parent remained a passive observer during the visit. Parents completed a survey assessing satisfaction with their childs dental visit. RESULTS More parents were rated as passive in the test group than in the control group, 67.3% vs. 32.1%, (P<0.01). However, no statistically significant difference was found in parental satisfaction between the test and the control group. CONCLUSION Asking parents to act as passive observers may help preserve the advantages of parental presence in the operatory while eliminating many of the disadvantages. A single preoperative instruction given orally by the treating dentist to be a passive observer was effective and did not lead to a reduction in parental satisfaction.