Suchergebnisse

ABSTRACTA survey was administered to 55 homeless adolescents and young adults aged 14 to 28 years who presented for care at a community health center in Seattle, Washington in 2005. Forty‐five valid surveys were analyzed. The aim of the study was to identify factors associated with self‐reported oral health. The most common self‐reported dental problem was sensitive teeth (52.6%), followed by discolored teeth (48.6%), toothache (38.5%), or a broken tooth (37.8%). Dental problems were associated with lower self‐reported oral health, while non‐high school graduates, mixed race youths, and methamphetamine users had significantly higher self‐reported oral health. Among homeless youths, addressing dental problems with direct dental care may improve self‐perceived oral health. The relationships between methamphetamine use and education level, on the one hand, and self‐reported oral health, on the other, are complex and may be modified by age.

Abstract Background To address dental workforce shortages in underserved areas in the United States, some States have enacted legislation to make it easier for foreign dental school graduates to become licensed dentists. However, the extent to which foreign dental school graduates will solve the problem of dental workforce shortages is poorly understood. Furthermore, the potential impact that foreign-trained dentists have on improving access to dental care for vulnerable patients living in dental Health Professional Shortage Areas (HPSAs) and those enrolled in public insurance programs, such as Medicaid, is unknown. The objective of this paper is to provide a preliminary understanding of the practice behaviors of foreign-trained dentists. The authors used Washington State as a case study to identify the potential impact foreign dental school graduates have on improving access to dental care for vulnerable populations. The following hypotheses were tested: a) among all newly licensed dentists, foreign-trained dentists are more likely to participate in the Medicaid program than U.S.-trained dentists; and b) among newly licensed dentists who participated in the Medicaid program, foreign-trained dentists are more likely to practice in dental HPSAs than U.S.-trained dentists. Methods The authors used dental license and Medicaid license data to compare the proportions of newly licensed, foreign- and U.S.-trained dentists who participated in the Medicaid program and the proportions that practiced in a dental HPSA. Results Using bivariate analyses, the authors found that a significantly lower proportion of foreign-trained dentists participated in the Medicaid program than U.S.-trained dentists (12.9% and 22.8%, respectively; P = 0.011). Among newly licensed dentists who participated in the Medicaid program, there was no significant difference in the proportions of foreign- and U.S.-trained dentists who practiced in a dental HPSA (P = 0.683). Conclusions Legislation that makes it easier for foreign-trained dentists to obtain licensure is unlikely to address dental workforce shortages or improve access to dental care for vulnerable populations in the United States. Licensing foreign dental school graduates in the United States also has ethical implications for the dental workforces in other countries.

Abstract The goal of this workshop is to develop a consensus within the biomaterials/bioengineering community for a research agenda focused on creating technologies that will address the current dental caries pandemic. The workshop will bring together expertise from academia, industry, and the NIH institutes in the areas of oral biofilm microbiology and innovative biomaterials. The rationale for the workshop is that science and technology have not produced sufficient practical tools for public health practitioners and the private delivery system to address the pandemic in dental caries that exists for children and adults from families with low incomes and for numerous ethnic minority and racial groups. Moreover, it is unclear whether the barriers are remediable bioengineering and technical problems or fundamental science questions. Nevertheless, the obligation to address the gap between scientific research and practical application is especially relevant today. The U.S. and state governments bear the majority of the cost of trying to control this pandemic through Medicaid, the Public Health Service, Indian Health Service and other similar programs. These costs continue to escalate as continued applications of existing technology are unlikely to markedly reduce disparities. The mainstays of caries prevention, topical and systemic fluorides and pit and fissure sealants, are technologies developed in the 1950s and 1960s.

In order to examine the clinical treatment outcome for dental fears, we examined 111 active patient records retrospectively using an 80‐item structured format. Subjects were from three fear subtypes: needle phobic (N = 15), gagger (N = 11), and non‐specific dental fear (N = 85). Mean subtype Dental Fear Survey scores ranged from 72.3 to 81.0. Patients received either behavioral therapy alone (N = 85) or behavioral therapy with a nitrous oxide or IV sedation adjunct (N = 26). Mean psychological treatment time was 3.9 hours (SD = 2.8 h) and did not differ by fear subtype (p > 0.05). All patients successfully completed initial dental treatment. Relapse of fear requiring additional psychological treatment occurred only in the nonspecific fear subtype (rate = 11.2%). Patients receiving pharmacological adjuncts to behavior therapy (nitrous oxide) experienced less relapse.

ABSTRACTPurposeThis study examined the preventive dental health care experiences of young children with special needs and determined the feasibility of conducting clinical dental examinations at a community‐based early intervention services center.MethodsStudy methods included 90 parent interviews and dental examinations of their preschool‐age children.ResultsThirteen percent of the children received optimal preventive care, defined as twice daily tooth brushing with fluoridated toothpaste and two preventive dental visits in the prior 12 months; 37% experienced care that fell short in both areas. Optimal care was more common among children of parents who reported tooth brushing was not a struggle and those with a personal dentist. Parents' opinion of the study experience was generally positive.ConclusionsFew children with special needs receive effective preventive care early, when primary prevention could be achieved. Barriers to optimal care could be readily addressed by the dental community in coordination with early intervention providers.

In order to examine the clinical treatment outcome for dental fears, we compared the records of 18 phobics who had co‐morbid substance use disorder (SUD) with those of 27 subjects who were phobic without concomitant SUD. Outcomes were determined by calculation of changes in the Dental Fear Survey (DFS score. Subjects were classified by the Structured Clinical Interview for DSM‐III‐R. All subjects received exposure based behavioral therapy with or without pharmacological adjuncts. All 27 subjects in the non‐SUD group and 15 of 18 (83.3%) of subjects in the SUD group improved. Non‐SUD subjects improved more than SUD's on the avoidance and specific fear, but not on the physioiogical upset, dimensions of the DFS.

ABSTRACTObjectiveTo identify factors associated with dentists' counseling of pregnant patients about periodontal health.MethodsSurvey data from Oregon general dentists (N = 771) were linked to county‐level data from the U.S. Area Resource Files and analyzed using two‐level hierarchical linear models.ResultsDentists who believed there is an important relationship between periodontal disease and adverse pregnancy outcomes counseled significantly larger proportions of pregnant patients (p < .0001). Female dentists (p < .05) and those who saw a greater number of pregnant patients (p < .05) were more likely to counsel. County‐level health workforce characteristics (e.g., percent female physicians, obstetricians or gynecologists, female dentists) were not significantly associated with dentists' counseling.ConclusionsDentists who were knowledgeable about periodontal disease were more likely to counsel pregnant patients. Future interventions should improve the oral health knowledge of dentists and other healthcare professionals regarding the importance of comprehensive dental care, including periodontal treatment when needed, for all pregnant patients.

ABSTRACTThe authors surveyed parent‐leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist–parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.