Comprehensive pregnancy dental benefits improved dental coverage and increased dental care utilization among Medicaid-enrolled pregnant women in Virginia

Objectives: To evaluate the changes in dental insurance and utilization among pregnant women before and after the pregnancy Medicaid dental benefit policy implementation in 2015 in Virginia. Methods: We used pooled cross-sectional data from six cycles of the Virginia Pregnancy Risk Assessment Monitoring System on women aged ≥21 years. Using logistic regression models and a difference-in-difference design, we compared the effects of policy implementation on dental insurance and utilization between pre-policy (2013-2014) and post-policy period (2016-2019) among women enrolled in Medicaid (treatment, N = 1,105) vs. those with private insurance (control, N = 2,575). A p-value of 0.05 was considered significant. Results: Among Medicaid-enrolled women, the report of dental insurance (71.6%) and utilization (37.7%) was higher in the post-period compared to their pre-period (44.4% and 30.3%, respectively) estimates but still remained lower than the post-period estimates among women with private insurance (88.0% and 59.9%, respectively). Adjusted analyses found that Medicaid-enrolled women had a significantly greater change in the probability of reporting dental insurance in all post-period years than women with private insurance, while the change in the probability of utilization only became statistically significant in 2019. In 2019, there was a 16 percentage point increase (95% CI = 0.05, 0.28) in the report of dental insurance and a 17 percentage point increase (95% CI = 0.01-0.33) in utilization in treatment group compared to controls. Conclusions: The 2015 pregnancy Medicaid dental benefit increased dental insurance and dental care utilization among Medicaid-enrolled women and reduced associated disparities between Medicaid and privately insured groups

Prenatal and Pediatric Oral Health Education Among Dental Hygiene Programs in the United States

Purpose: Health care and dental providers must be prepared to address the oral health needs of mothers and children in order to reduce the burden of dental disease in these populations. The purpose of this study was to describe the curriculum and clinical experiences related to prenatal and pediatric oral health in the university and community college dental hygiene programs in the United States (US). Methods: Dental hygiene program directors (PDs) from across the US were invited to participate in a cross-sectional electronic survey regarding the prenatal and pediatric oral health curriculum at their institution. In addition to program characteristics, the survey included items pertaining to curriculum and competencies, content delivery methods and hours spent, locations for clinical experiences, collaboration efforts, and professional policy guidelines. Responses were summarized, and descriptive analyses were conducted to examine program competency and curriculum by program type. Results: A total of 124 PDs responded to the survey for a 37.9% response rate; over half (54%) were based in community colleges. Overall, most PDs indicated prenatal (77.3%) and pediatric oral health (66.1%) as a part of their program\u27s core curriculum. However, prenatal oral health was a core competency for 52% of the respondents and less than half (46%) considered pediatric oral health a core competency. Most programs (\u3e75%) reported teaching professional policies and guidelines. Universities reported more hours for prenatal and didactic and clinical experiences than community colleges. The most common barrier reported for prenatal and pediatric clinical experience was the lack of patients (55% and 35%, respectively). Conclusions: Most dental hygiene programs are utilizing a variety of methodologies to incorporate prenatal and pediatric content into the curriculum and students are being exposed to professional guidelines and recommendations for these populations. However, patient care experiences for prenatal and pediatric patients were low due to lack of patients

Opioid and Nonopioid Analgesic Prescriptions for Dental Visits in the Emergency Department, 2015-2017 National Hospital Ambulatory Medical Care Survey

Introduction: Prescription and nonprescription opioid misuse and the rising number of dental visits in emergency departments (EDs) are growing public health concerns in the US. Our study objective was to examine the relationship between prescription analgesics (opioids and nonopioids) and the type of ED visits (dental and nondental) at the national level. Methods: We used data from the 2015-2017 National Hospital Ambulatory Medical Care Survey to examine the association between opioid, nonopioid, and combination of opioid and nonopioid analgesic prescriptions and dental and nondental visits in the ED. Covariates included socioeconomic variables, time of visit, provider type, triage level, hospital location (urban vs rural), and pain level. We conducted descriptive, bivariate, and multivariable analyses using weighted estimates. Results: The final study sample included 57,098 ED visits from approximately 6 million dental and 414 million nondental visits to EDs during 2015-2017 nationally. Among dental visits, 20.8% received nonopioid analgesics (vs 23.4% among nondental visits), 36.6% received opioid analgesics (vs 14.0% among nondental visits), and 17.7% received both opioids and nonopioid analgesics (vs 8.7% among nondental visits). Adjusted multinomial logistic regression model indicated that, compared with nondental visits, dental visits had 4.8, 1.9, and 3.4 times higher likelihood of receipt of an opioid, nonopioid, or both opioid and nonopioid analgesic prescription, respectively, in the ED than no analgesic prescriptions. Conclusion: Dental visits resulted in receipt of a significantly higher proportion of opioid prescriptions compared with nondental visits during 2015-2017. The study findings highlight the need for developing interventions to reduce opioid prescriptions in the ED, especially for dental visits

Describing Trends in Virginia\u27s Dentist and Dental Hygienist Workforce: Challenges and Opportunities

Purpose: Regular assessment of the dental workforce is essential to improve the population\u27s oral health. This analysis aimed to understand the trends in the distribution of dentists and dental hygienists (DHs) in Virginia. Methods: Annual survey data (2013-2022) of dentists and DHs from the Virginia Department of Health Professions Healthcare Workforce Data Center was used to examine the trends in provider distribution by age, gender, race/ethnicity, and geography across Virginia. Results: In 2022, there were 5,720 dentists and 5,290 DH licensees in Virginia. In the dentist workforce, there was a high representation of those aged ≥60 years (23%), males (58%), and Whites (59%). On the other hand, the DH workforce has been predominantly females (98%) and Whites (76%), and the age groups were more evenly distributed. Black dentists and DH were highly underrepresented; compared to the 19% Black population in Virginia, only 6% and 5.2% of dentists and DH workforce were Black, respectively. Over time, several counties have seen a decline in FTEs in dentists compared to DHs. In 2022, 9 counties lacked a dentist/DH or both, and 79 counties had lower dentist and DH FTEs than the state average (0.5 FTE for dentists and 0.4 FTE for DH). Discussion: Virginia\u27s dentist and DH workforce have seen some diversification in the past decade, but significant work needs to be done to gain diversity and equity. Conclusion and recommendations: The development of targeted programs and policies to improve professional entry, growth, and retention is necessary to maintain a sustainable, diverse, and representative workforce and address the oral health needs of Virginians

Recommendations for Exploring the Impact of the Opioid Epidemic: A Proposed Management Framework

It is imperative to prepare Business School Health Services Administration (HSAD) graduates with management tools to assess patient need and reduce barriers to care alongside clinicians. HSAD programs require interprofessional learning activities to shape competency and skill in community needs assessment. This HSAD program works collaboratively across the University community and with external partners to offer such an experience. Integrating this concept into the curriculum encourages graduates as early careerists to implement services and resources for patient need. Understanding that problems exists is a precursor to an economic valuation of such prevalent conditions as the dynamic opioid epidemic

Utilization of Dental Services Among Medicaid Enrolled Pregnant Women in Virginia

The study evaluated the impact of the Virginia Medicaid dental benefit on dental services utilization among pregnant women enrolled in Medicaid. Data from a total of 10,395 women who had at least one dental claim during the 2015-2017 period were included in the study. The number of dental visits and dental services utilized per person grew from an average of 2.2 visits and 7 services in 2015 to 3.1 visits and 10.5 services in 2017, respectively. In 2017, of all dental services used, 6% were for preventive services and 59% were for treatment services. Continued efforts and targeted interventions are required to improve the oral health of pregnant women enrolled in Virginia Medicaid

Impact of Making Dental Care Affordable on Quality of Life in Adults Aged 45 Years and Older

Objective: The objective of this study was to examine the associations between self-reported ability to afford dental care and quality of life in adults aged 45 years and older. Method: We used publicly available cross-sectional data from the 2008 National Health Interview Survey and its oral health supplement for 11,760 adults aged 45+ years. The increased probabilities of reporting dental problems attributable to an inability to afford dental care were estimated from multivariate models and combined with respective dental problem disability weights from the Global Burden of Disease to measure loss in quality of life. Results: Prevalence of reported inability to afford dental care, severe tooth loss, severe periodontitis, and untreated caries were 11.9%, 8.5%, 14.3%, and 37.9%, respectively. Inability to afford dental care was associated with an increase of 0.017 disability-adjusted life-years (DALYs) per person per year under base case and 0.020 DALYs under generous assumptions. Conclusion: Making dental care affordable could improve adult’s (age 45 and above) quality of life at a reasonable cost

The contribution of different permanent tooth types to untreated caries: Implications for public health surveillance and prevention

Background: Untreated caries (UC), although highly prevalent, is largely preventable. Information on the contribution of different teeth to UC prevalence and severity could be helpful in evaluating UC surveillance protocols and the relative benefits of caries prevention interventions. Methods: The authors combined data from 3 cycles (2011-2016) of the National Health and Nutrition Examination Survey for participants aged 6 through 11 years, 12 through 19 years, 20 through 34 years, 35 through 49 years, 50 through 64 years, 65 through 74 years, and 75 years and older. For each age group the authors calculated the contribution of successive permanent tooth types (for example, first molars and second molars) to UC prevalence and severity. Results: UC prevalence and the percentage of prevalence detected by means of screening molars were, respectively, 5% and 95% among participants aged 6 through 11 years; 16% and 92% among participants aged 12 through 19 years; 29% and 86% among participants aged 20 through 34 years; 26% and 70% among participants aged 35 through 49 years; 21% and 48% among participants aged 50 through 64 years; 16% and 36% among participants aged 65 through 74 years; and 17% and 25% among participants 75 years and older. Among adults aged 50 years and older, no teeth appeared to capture a disproportionate share of UC prevalence. Molars accounted for 87%, 79%, and 56% of severity among participants aged 6 through 11 years, 12 through 19 years, and 20 through 34 years, respectively. After age 34 years, molars accounted for less than 50% of severity. Conclusions: Molars are the tooth type most susceptible to UC well into adulthood. Practical implications: Molars could be used as sentinel teeth for surveillance of UC and adults could benefit from caries prevention that targets molars