52 research outputs found
Dental Caries: Racial and Ethnic Disparities Among North Carolina Kindergarten Students
Objectives. We examined racial/ethnic disparities in dental caries among kindergarten students in North Carolina and the cross-level effects between students’ race/ethnicity and school poverty status. Methods. We adjusted the analysis of oral health surveillance information (2009–2010) for individual-, school-, and county-level variables. We included a cross-level interaction of student’s race/ethnicity (White, Black, Hispanic) and school National School Lunch Program (NSLP) participation (< 75% vs ‡ 75% of students), which we used as a compositional school-level variable measuring poverty among families of enrolled students. Results. Among 70 089 students in 1067 schools in 95 counties, the prevalence of dental caries was 30.4% for White, 39.0% for Black, and 51.7% for Hispanic students. The adjusted difference in caries experience between Black and White students was significantly greater in schools with NSLP participation of less than 75%. Conclusions. Racial/ethnic oral health disparities exist among kindergarten students in North Carolina as a whole and regardless of school’s poverty status. Furthermore, disparities between White and Black students are larger in nonpoor schools than in poor schools. Further studies are needed to explore causal pathways that might lead to these disparities
Comparative Effectiveness of the Mode of Delivery for Preventing Dental Caries in Young Children
Background. Most state Medicaid programs reimburse primary care providers for providing preventive oral health services to young children in medical offices. Since 2000, North Carolina (NC) Medicaid has reimbursed these services through the Into the Mouths of Babes (IMB) program. To understand how the provider of oral health services may affect children's subsequent oral health-related outcomes, we compared children enrolled in NC Medicaid who received only IMB visits, only dentist visits, both IMB and dentist visits, and neither before 3 years of age. Methods. Using a combination of NC administrative and public health surveillance data from 2000 to 2006, this study used regression methods to examine the following outcomes occurring after a child's third birthday: (1) time to a dentist visit; (2) receipt of caries-related treatment (CRT) and associated payments; (3) and the number of decayed, missing, and filled teeth (dmft) and proportion of untreated decayed teeth. Results. Most children did not receive any preventive oral health services before age three; those who did were more likely to have IMB visits than dentist visits. Children who had only IMB visits had a longer time to a dentist visit following their third birthday, fewer CRT, and lower CRT payments than children who visited only dentists before age 3. Children who had multiple IMB or dentist visits had a similar number of dmft in kindergarten, but children with only IMB visits had a higher proportion of untreated decayed teeth. Conclusions. Although few children received preventive oral health services before age 3, those who did were more likely to have IMB visits than dentist visits. The similar dmft count of children with repeat IMB or dentist visits suggests that provider type does not influence the effectiveness of these services. However, children with only IMB visits may encounter challenges to obtaining follow-up treatment for tooth decay as these children experienced a longer time to a dentist visit following their third birthday and had more untreated decayed teeth. Results support the dissemination of this innovative model developed in NC, but also suggest enhancements are needed in linking medical and dental providers.Doctor of Philosoph
Extending the Touchscreen Pattern Lock Mechanism with Duplicated and Temporal Codes
We investigate improvements to authentication on mobile touchscreen phones and present a novel extension to the widely used touchscreen pattern lock mechanism. Our solution allows including nodes in the grid multiple times, which enhances the resilience to smudge and other forms of attack. For example, for a smudge pattern covering 7 nodes, our approach increases the amount of possible lock patterns by a factor of 15 times. Our concept was implemented and evaluated in a laboratory user test (n = 36). The test participants found the usability of the proposed concept to be equal to that of the baseline pattern lock mechanism but considered it more secure. Our solution is fully backwards-compatible with the current baseline pattern lock mechanism, hence enabling easy adoption whilst providing higher security at a comparable level of usability
Oral Health Content of Early Education and Child Care Regulations and Standards
Almost two out of every three U.S. children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers
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Dental Fluoride Varnish Application During Medical Visits Among Children Who Are Privately Insured
This cross-sectional study examines fluoride varnish application rates during well-child medical visits and identify characteristics associated with fluoride varnish receipt
Care coordination among pediatricians and dentists: a cross-sectional study of opinions of North Carolina dentists
Abstract: Background: Care coordination between physicians and dentists remains a challenge. This study of dentists providing pediatric dental care examined their opinions about physicians’ role in oral health and identified factors associated with these opinions. Methods: North Carolina general and pediatric dentists were surveyed on their opinions of how physicians should proceed after caries risk assessment and evaluation of an 18-month-old, low risk child. We estimated two multinomial logistic regression models to examine dentists’ responses to the scenario under the circumstances of an adequate and a limited dental workforce. Results: Among 376 dentists, 52% of dentists indicated physicians should immediately refer this child to a dental home with an adequate dental workforce. With a limited workforce, 34% recommended immediate referral. Regression analysis indicated that with an adequate workforce guideline awareness was associated with a significantly lower relative risk of dentists’ recommending the child remain in the medical home than immediate referral. Conclusions: Dentists’ opinions and professional guidelines on how physicians should promote early childhood oral health differ and warrant strategies to address such inconsistencies. Without consistent guidelines and their application, there is a missed opportunity to influence provider opinions to improve access to dental care
Oral Health Activities of Early Head Start and Migrant and Seasonal Head Start Programs
Guidelines recommend that Migrant and Seasonal Head Start programs (MSHS) address the dental needs of children of migrant and seasonal farmworkers. This study describes parent- and child-oriented oral health activities of North Carolina’s MSHS programs and compares them with non-migrant Early Head Start (EHS) programs using data collected from a questionnaire completed by teachers and family services staff. MSHS staff reported engaging in more oral health activities than EHS staff, which was confirmed by results of logit and ordered logit regression models. Despite promising findings about the engagement of MSHS staff, participation in oral health activities is lower than recommended. Differences between EHS and MSHS programs might be due to differing needs of enrolled children and families or to different approaches to meeting the needs of families
Oral Health Activities of Early Head Start Teachers Directed toward Children and Parents
Objectives—This cross-sectional study examined Early Head Start (EHS) teachers’ oral health
program activities and their association with teacher and program characteristics.
Methods—Self-complete questionnaires were distributed to staff in all EHS programs in North
Carolina. Variables for dental health activities for parents (4 items) and children (4 items) were
constructed as the sum of responses to a 0-4 Likert-type scale (never to very frequently). Ordinary
least squares regression models examined the association between teachers’ oral health program
activities and modifiable teacher (oral health knowledge, values, self-efficacy, dental health
training, perceived barriers to dental activities) and program (director and health coordinator
knowledge and perceived barriers to dental activities) characteristics.
Results—Teachers in the parent (n=260) and child (n=231) analyses were a subset of the 485
staff respondents (98% response rate). Teachers engaged in child oral health activities
(range=0-16; mean=9.0) more frequently than parent activities (range=0-16; mean=6.9). Teachers’
oral health values, perceived oral health self-efficacy, dental training, and director and health
coordinator knowledge were positively associated with oral health activities (P<0.05). Perceived
barriers were negatively associated with child activities (P<0.05).
Conclusion—The level of oral health activity in EHS programs is less than optimal. Several
characteristics of EHS staff were identified that can be targeted with education interventions.
Evidence for effectiveness of EHS interventions needs to be strengthened, but results of this
survey provide encouraging findings about the potential effects of teacher training on their oral
health practices
Barriers to Pediatricians’ Adherence to American Academy of Pediatrics Oral Health Referral Guidelines: North Carolina General Dentists’ Opinions
Purpose—The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of
North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental
referral guidelines; and (2) determine factors that influence pediatricians’ ability to comply with
AAP guidelines.
Methods—One thousand GDs were surveyed to determine barriers toward acceptance of
physician referrals of infants and toddlers. The primary outcome using ordered logistic regression
was GDs’ acceptance of children described in five case scenarios, with different levels of risk and
oral health status.
Results—GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61
to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only
35 percent would accept referrals when caries was present. Predictors of referral acceptance were
correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in pro- viding
preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see
importance in dental referrals (OR=2.1, 95% CI=1.2-3.6).
Conclusions—This study identified factors influencing acceptance of pediatrician referrals for
the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face
in referring young children for dental care
Cost-effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees
Dental caries is the most common preventable chronic disease among preschool children. The pediatric primary care setting provides an alternative site to deliver preventive oral health. This study estimates the cost-effectiveness of a medical office-based preventive oral health program in North Carolina (“Into the Mouths of Babes,” IMB)
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