Evaluating the quality and efficacy of care provided by extended care permit dental hygienists in a school based dental home

Title from PDF of title page, viewed on December 2, 2013Dissertation advisor: Bonnie BransonVitaIncludes bibliographic references (pages 63-70)Thesis (Ph,D.)--School of Dentistry and Henry W. Bloch School of Management. University of Missouri--Kansas City, 2013Lack of access to oral health care is a growing problem for low income children in the United States. One proposed solution to this problem is utilizing dental hygienists to the full extent of their education and training. In 2003, Kansas altered the dental hygiene scope of practice and supervision regulations through the creation of the extended care permit (ECP) dental hygienist. In 2008, a school-based oral health intervention, that utilized ECP dental hygienists to provide preventive oral health care and referrals, was established in a Midwestern city suburb. The purpose of this case study was to assess the quality of oral health care provided by ECP dental hygienists. The central hypothesis of this investigation was ECP dental hygienists provide quality oral health care that improves the oral health of underserved children in a school-based setting. Using a case-study design, electronic medical records of children (n=986) who participated in the intervention were mined for data. Numerators and denominators from the Dental Quality Alliance Concept Set provided the framework for measurement. Patient-oriented outcomes were examined in a multi-encounter cohort (n=295) using MANOVA and Kruskal Wallace. Results revealed 26.3% of the children eligible to participate in the intervention chose to do so. On average 96.6% of the children were provided a minimum of one topical fluoride application and 34.0% had at least one sealant placed. Nearly half (48.7%) of the program participants had two or more topical fluoride applications. On average 52.8% of the children had sealants placed. The number of encounters with ECP dental hygienists had a statistically significant effect on changes in decay (p=0.014), changes in restorations (p=0.002) and changes in treatment urgency (p=0.022). A statistically significant effect of the number of fluoride applications on changes in restorations (p.0.031) was also present. These results suggests ECP dental hygienists can provide access to and the provision of timely and appropriate quality oral health care for low income children in a school-based setting and oral health care provided by ECP dental hygienists can improve the oral health status of low income children who lack access to oral health care.Introduction -- Methods -- Results -- Discussion -- Conclusion -- Literature cited -- Appendix 1. Glossary of terms -- Appendix 2. Dental quality alliance starter set of measure

Assessing the Effectiveness of a School-Based Dental Clinic on the Oral Health of Children Who Lack Access to Dental Care: A Program Evaluation

This program evaluation examines the effectiveness of a school-based dental clinic. A repeated-measures design was used to longitudinally examine secondary data from participants (N = 293). Encounter intensity was developed to normalize data. Multivariate analysis of variance and Kruskal–Wallis test were used to investigate the effect of encounter intensity on the change in decay, restorations, and treatment urgency. A Pearson’s correlation was used to measure the strengths of association. Encounter intensity had a statistically significant effect on change in decay (p =.005), restorations (p =.000), and treatment urgency (p =.001). As encounter intensity increased, there was a significant association with the decrease in decay (−.167), increase in restorations (.221), and reduction in referral urgency (−.188). Incorporating dental care into a school-based health center resulted in improved oral health in underserved children while overcoming barriers that typically restrict access. The collaboration of school nurses with the school-based dental clinic was an important element for maximizing student access to dental care

Gender Differences in the Association of Periodontitis and Type 2 Diabetes

Aims: The objective was to investigate if gender differences exist in the associations between periodontitis and type 2 diabetes. Disproportionate disparities by gender were found to exist in rates of both periodontitis and diabetes with respect to demographics and behavioural predictors that cannot be explained solely by the well-established association between these two diseases. Materials and methods: Multiple datasets were extracted from the National Health and Nutrition Examination Survey (NHANES) 2009–2014, which used a stratified multistage probability sampling to obtain samples from all civilian non-institutionalised people in the USA. Bivariate relationships between each explanatory variable and periodontitis level were assessed with odds ratios (OR) and their 95% confidence intervals (CI). A set of weighted logistic regression models was used to investigate the association differentiations between periodontitis and diabetes by gender. C-statistics measured the goodness-of-fit of weighted logistic regression models. Results: The prevalence of moderate–severe periodontitis was 36.39% and 22.71% among participants with type 2 diabetes and without diabetes, respectively. Type 2 diabetes was significantly associated with moderate–severe periodontitis OR (OR = 1.47, 95% CI: 1.18–1.82) among males even after adjusting for demographics, socioeconomic status and oral health behaviours. The aforementioned relationship was not found in females. Furthermore, different relationships of moderate–severe periodontitis with body mass index and the use of mouthwash were found between the males and females. Conclusions: The current findings suggest that important improvements in the development of gender-specific strategies in prevention, such as oral home-care, to reduce the high prevalence of periodontal disease and maintain good oral health are vital, and are especially important for male diabetic patients and those who are at high risk of developing diabetes, such as those who are obese