Patient Characteristics and Trends in Nontraumatic Dental Condition Visits to Emergency Departments in the United States

Objective: We examined trends and patient characteristics for non-traumatic dental condition (NTDC) visits to emergency departments (EDs), and compared them to other ED visit types, specifically non-dental ambulatory care sensitive conditions (non-dental ACSCs) and non-ambulatory care sensitive conditions (non-ACSCs) in the United States. Methods: We analyzed data from the National Hospital Ambulatory Medical Care survey (NHAMCS) for 1997 to 2007. We performed descriptive statistics and used a multivariate multinomial logistic regression to examine the odds of one of the three visit types occurring at an ED. All analyses were adjusted for the survey design. Results: NTDC visits accounted for 1.4% of all ED visits with a 4% annual rate of increase (from 1.0% in 1997 to 1.7% in 2007). Self-pay patients (32%) and Medicaid enrollees (27%) were over-represented among NTDC visits compared to non-dental ACSC and non-ACSC visits (P \u3c 0.0001). Females consistently accounted for over 50% of all types of ED visits examined. Compared to whites, Hispanics had significantly lower odds of an NDTC visit versus other visit types (P \u3c 0.0001). Blacks had significantly lower odds of making NDTC visits when compared to non-dental ACSC visits only (P \u3c 0.0001). Compared to private insurance enrollees, Medicaid and self-pay patients had 2–3 times the odds of making NTDC visits compared to other visit types. Conclusion: Nationally, NTDC visits to emergency departments increased over time. Medicaid and self-pay patients had significantly higher odds of making NDTC visits

Senior Dental Students’ Experience with Cariogram in a Pediatric Dentistry Clinic

The study objective was to assess predoctoral dental students’ experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program “Cariogram.” The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school

Trends and Racial/Ethnic Disparities in Antibiotic Prescribing Practices of Dentists in The United States

Objective The aim of this study was to examine trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States. Methods The US Medical Expenditure Panel Survey data for 1996‐2013 was analyzed. Information on patient sociodemographic characteristics, dental visits, receipt of dental procedures, and type of antibiotics prescribed following visits was obtained. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to identify associations during the period with and without adjustment for dental procedures and sociodemographic characteristics. Survey weights were incorporated to handle the sampling design. Results Nationally, the number of antibiotic prescribed at dental visits was estimated to be higher by 842,749 (0.4 percent) at year 2013 compared to the prescription level at 2003 were the population sociodemographic distribution kept at 2013 level. On average, the odds of prescribing antibiotics following dental care increased with each decade of study (OR: 1.10; 95% CI: [1.04, 1.17]) after adjusting for sociodemographic characteristics and receipt of dental procedures. Compared to Whites, Blacks had 21 percent (95% CI: 11%, 31%) higher odds of receiving a prescription for antibiotics from a dentist after adjusting for dental procedure and other sociodemographic characteristics. Conclusions The prescription of antibiotics following dental visits increased over time after adjustment for sociodemographic characteristics and dental procedure. The probability of being prescribed antibiotics by dentists was higher for Blacks compared to Whites

Patterns of Dental Service Utilization Following Nontraumatic Dental Condition Visits to the Emergency Department in Wisconsin Medicaid

Objectives: To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED). Methods: This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist. Results: We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 toyears) and enrollees living in counties with a lower supply of dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit. Conclusions: Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions

Opioid Analgesic Prescribing Practices of Dental Professionals in the United States

The prescription of opioid analgesics by dental professionals is widespread in the United States. Policy makers, government agencies, and professional organizations consider this phenomenon a growing public health concern. This study examined trends in the prescription of opioid analgesics for adults by dental professionals and associated factors in the United States. Data from the Medical Expenditure Panel Survey (1996-2013) were analyzed. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to estimate the overall trend during the period with and without adjusting for dental procedures and personal characteristics. Survey weights were incorporated to handle the sampling design. The prescription of opioid analgesics following dental care increased over time. After adjusting for sociodemographic factors, source of payment, and type of dental procedure, the odds ratio (OR) of prescribing opioid analgesics following a dental visit per each decade difference was 1.28 (95% confidence interval [CI], 1.19–1.38). Surgical, root canal, and implant procedures had the highest rates of opioid prescriptions and the greatest increases in rates over the study period. After adjusting for personal characteristics and type of dental procedure, the OR of receiving a prescription for opioids comparing blacks, Asians, and Hispanics to whites was 1.29 (95% CI, 1.17–1.41), 0.57 (95% CI, 0.47–0.70), and 0.84 (95% CI, 0.75–0.95), respectively. Opioid analgesic prescriptions following dental visits increased over time after adjusting for personal characteristics and type of dental procedure. The odds of receiving a prescription for opioids were higher for certain racial/ethnic minority groups. Knowledge Transfer Statement: This study highlights dental professionals prescribing practices of opioid analgesics by following dental treatments in the United States. With this knowledge, appropriate guidelines, protocols, and policies can be developed and implemented to address any inappropriate prescribing practices of opioid analgesics. In addition, this information could lead to an improvement in the prescribing practices of dental professionals and to evidence-based therapeutic decision making

Erosive Tooth Wear and Consumption of Beverages among Children in the United States

Background/Aim: Experimental studies have identified differences in the effect of physicochemical properties of beverages on the etiology of erosive tooth wear (ETW). Little is known from epidemiological studies about the relationship between ETW and consumption of juices, drinks and milk. This study examined the relationship between the consumption of juices, drinks, milk and ETW in children in the United States. Methods: The National Health and Nutrition Examinations Survey data for 2003–2004 was analyzed. Trained and calibrated examiners used the modified Smith and Knight Tooth Wear Index from a 1998 United Kingdom Adult Health Survey to measure ETW. Beverage consumption collected via a Food Frequency Questionnaire was processed with Diet*Calc software to obtain the average daily consumption frequency for all queried juice categories, milk and carbonated beverages. Survey-weighted descriptive and multivariable analyses were performed. Results: Prevalence of ETW was highest in children aged 18–19 years (56%), males (49%), and lowest in Blacks (31%). Milk and soft drinks (0.85 times a day) and fruit drinks (0.69) were the most consumed products by children. Children with ETW had significantly higher odds of being frequent consumers of apple juice after adjusting for age, gender, and race/ethnicity. Blacks had the highest mean daily apple juice consumption, but the mean difference between those with ETW and those without ETW was not significant. Conclusion: ETW was associated with frequent intake of apple juice, but the mean difference in consumption between groups with ETW versus those without ETW within racial/ethnic groups was not significant

Dental Service Utilization and Neighborhood Characteristics in Young Adults in The United States: A Multilevel Approach

Objective: To investigate the association between neighborhood level factors and dental visits in young adults in the United States after adjusting for individual level factors. Methods: The National Longitudinal Study of Adolescent Health Wave 1 (1994-1995) to Wave III (2001-2002) was analyzed. The primary outcome of having had at least one dental visit in the previous 12 months was analyzed via a multilevel random-effects logistic model accounting for geographic clustering in Wave III and survey design clustering from Wave I. Neighborhood level covariates were defined at the census tract level. Results: Overall rate of dental visits was 57 percent, highest among 18-20 year olds (65 percent) and lowest in 23-26 year olds (52 percent). Increased proportion of African-Americans (≤5 percent to ≥20 percent) and Hispanics (≤5 percent to ≥20 percent) in a neighborhood corresponded with a decrease in dental visits (60 percent versus 52 percent) and (58 percent versus 51 percent), respectively. Neighborhoods with a high proportion of college-educated residents had a higher percentage of dental visits. Similar differences were found when comparing the lowest and highest tertiles defined by poverty level and unemployment with dental visits. Neighborhood education was significantly associated with dental service utilization after adjustment for individual level factors and dental utilization in adolescence (Waves I and II) in the random effects model. Conclusions: This study demonstrates that the education level of residents within a neighborhood was associated with dental service utilization in young adults in the United States

Predictors of Dental Care Use: Findings From the National Longitudinal Study of Adolescent Health

Purpose To examine longitudinal trends and associated factors in dental service utilization by adolescents progressing to early adulthood in the United States. Methods The data source was the National Longitudinal Study of Adolescent Health from Waves I (1994–1995), II (1996), III (2001–2002), and IV (2007–2008). This was a retrospective, observational study of adolescents\u27 transition to early adulthood. We obtained descriptive statistics and performed logistic regression analyses to identify the effects of baseline and concurrent covariates on dental service utilization from adolescence to early adulthood over time. Results Dental service utilization within the prior 12 months peaked at age 16 (72%), gradually decreased until age 21 (57%), and remained flat thereafter. Whites and Asians had a 10–20 percentage points higher proportion of dental service utilization at most ages compared with Blacks and Hispanics. Dental service utilization at later follow-up visits was strongly associated with baseline utilization, with odds ratio = 10.7, 2.4, and 1.5 at the 1-, 7-, and 13-year follow-ups, respectively. These effects decreased when they were adjusted for current income, insurance, and education. Compared with Whites, Blacks were consistently less likely to report a dental examination. Conclusions Dental service utilization was highest in adolescence. Gender, education, health insurance, and income in young adulthood were significant predictors in reporting a dental examination. Blacks had lower odds of reporting a dental examination, either as adolescents or as young adults