Effects of Physician-Based Preventive Oral Health Services on Dental Caries

Most Medicaid programs reimburse nondental providers for preventive dental services. We estimate the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students, hypothesizing improved oral health among students with medical visits with POHS

Office-Based Preventive Dental Program and Statewide Trends in Dental Caries

To evaluate the impact of a North Carolina Medicaid preventive dentistry program in primary care medical offices (Into the Mouths of Babes Program [IMBP]) on decayed, missing, and filled teeth (dmft) of kindergarten students statewide and in schools with a large proportion of students from low-income families

How A North Carolina Program Boosted Preventive Oral Health Services For Low-Income Children

Dental caries, the most common chronic disease affecting young children, is exacerbated by limited access to preventive dental services for low-income children. To address this problem, North Carolina implemented a program to reimburse physicians for up to six preventive oral health visits for Medicaid-enrolled children younger than 36 months. Analysis of physician and dentist Medicaid claims from 2000 to 2006 shows the program substantially increased preventive oral health services. By 2006 approximately 30% of well-child visits for 6- to 36-month old children included these services. Additional strategies are needed to ensure preventive oral health care for more low-income children

Mightyl: A compositional translation from mitl to timed automata

Metric Interval Temporal Logic (MITL) was first proposed in the early 1990s as a specification formalism for real-time systems. Apart from its appealing intuitive syntax, there are also theoretical evidences that make MITL a prime real-time counterpart of Linear Temporal Logic (LTL). Unfortunately, the tool support for MITL verification is still lacking to this day. In this paper, we propose a new construction from MITL to timed automata via very-weak one-clock alternating timed automata. Our construction subsumes the well-known construction from LTL to Büchi automata by Gastin and Oddoux and yet has the additional benefits of being compositional and integrating easily with existing tools. We implement the construction in our new tool MightyL and report on experiments using Uppaal and LTSmin as back-ends

Preventive Services by Medical and Dental Providers and Treatment Outcomes

Objective: Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment. Methods: We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding. Results: We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment =$234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr. Conclusions: Because of children’s increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs

Influence of Caregivers and Children's Entry Into the Dental Care System

Early preventive dental visits are essential in improving children’s oral health, especially young children at high risk for dental caries. However, there is scant information on how these children enter the dental care system. Our objectives were as follows: (1) to describe how a population-based cohort of young Medicaid-enrolled children entered dental care; and (2) to investigate the influence of caregiver characteristics on their children’s dental care–seeking patterns

More Scalable LTL Model Checking via Discovering Design-Space Dependencies (D3)

Modern system design often requires comparing several models over a large design space. Different models arise out of a need to weigh different design choices, to check core capabilities of versions with varying features, or to analyze a future version against previous ones. Model checking can compare different models; however, applying model checking off-the-shelf may not scale due to the large size of the design space for today’s complex systems. We exploit relationships between different models of the same (or related) systems to optimize the model-checking search. Our algorithm, D3 , preprocesses the design space and checks fewer model-checking instances, e.g., using nuXmv. It automatically prunes the search space by reducing both the number of models to check, and the number of LTL properties that need to be checked for each model in order to provide the complete model-checking verdict for every individual model-property pair. We formalize heuristics that improve the performance of D3 . We demonstrate the scalability of D3 by extensive experimental evaluation, e.g., by checking 1,620 real-life models for NASA’s NextGen air traffic control system. Compared to checking each model-property pair individually, D3 is up to 9.4 × faster

Parental perceptions of children's oral health: The Early Childhood Oral Health Impact Scale (ECOHIS)

BACKGROUND: Dental disease and treatment experience can negatively affect the oral health related quality of life (OHRQL) of preschool aged children and their caregivers. Currently no valid and reliable instrument is available to measure these negative influences in very young children. The objective of this research was to develop the Early Childhood Oral Health Impact Scale (ECOHIS) to measure the OHRQL of preschool children and their families. METHODS: Twenty-two health professionals evaluated a pool of 45 items that assess the impact of oral health problems on 6-14-year-old children and their families. The health professionals identified 36 items as relevant to preschool children. Thirty parents rated the importance of these 36 items to preschool children; 13 (9 child and 4 family) items were considered important. The 13-item ECOHIS was administered to 295 parents of 5-year-old children to assess construct validity and internal consistency reliability (using Cronbach's alpha). Test-retest reliability was evaluated among another sample of parents (N = 46) using the intraclass correlation coefficient (ICC). RESULTS: ECOHIS scores on the child and parent sections indicating worse quality of life were significantly associated with fair or poor parental ratings of their child's general and oral health, and the presence of dental disease in the child. Cronbach's alphas for the child and family sections were 0.91 and 0.95 respectively, and the ICC for test-retest reliability was 0.84. CONCLUSION: The ECOHIS performed well in assessing OHRQL among children and their families. Studies in other populations are needed to further establish the instrument's technical properties

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care

Background: Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Methods: Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. Results: From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training nondental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. Conclusions: This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector

A new method for chlorhexidine (CHX) determination: CHX release after application of differently concentrated CHX-containing preparations on artificial fissures

Aims of the study were (1) to establish a method for quantification of chlorhexidine (CHX) in small volumes and (2) to determine CHX release from differently concentrated CHX-containing preparations, varnishes, and a CHX gel applied on artificial fissures. CHX determination was conducted in a microplate reader using polystyrene wells. The reduced intensity of fluorescence of the microplates was used for CHX quantification. For verification of the technique, intra- and inter-assay coefficients of variation were calculated for graded series of CHX concentrations, and the lower limit of quantification (LLOQ) was determined. Additionally, artificial fissures were prepared in 50 bovine enamel samples, divided into five groups (A–E, n = 10) and stored in distilled water (7 days); A: CHX-varnish EC40; B: CHX-varnish Cervitec; C: CHX-gel Chlorhexamed; D: negative control, no CHX application; and E: CXH-diacetate standard (E1, n = 5) or CHX-digluconate (E2, n = 5) in the solution. The specimens were brushed daily, and CHX in the solution was measured. The method showed intra- and inter-assay coefficients of variation of <10 and <20%, respectively; LLOQ was 0.91–1.22 nmol/well. The cumulative CHX release (mean ± SD) during the 7 days was: EC40 (217.2 ± 41.8 nmol), CHX-gel (31.3 ± 8.5 nmol), Cervitec (18.6 ± 1.7 nmol). Groups A–C revealed a significantly higher CHX release than group D and a continuous CHX-release with the highest increase from day 0 to 7 for EC40 and the lowest for Chlorhexamed. The new method is a reliable tool to quantify CHX in small volumes. Both tested varnishes demonstrate prolonged and higher CHX release from artificial fissures than the CHX-gel tested