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Dental Care Coverage and Use: Modeling Limitations and Opportunities

January 17, 2014 Comments off

Dental Care Coverage and Use: Modeling Limitations and Opportunities (PDF)
Source: American Journal of Public Health

Objectives.
We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.

Methods.
We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.

Results.
Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.

Conclusions.
Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.

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New From the GAO

September 12, 2013 Comments off

New GAO Reports
Source: Government Accountability Office

1. Information Technology: Key Federal Agencies Need to Address Potentially Duplicative Investments. GAO-13-718, September 12.
http://www.gao.gov/products/GAO-13-718
Highlights - http://www.gao.gov/assets/660/657791.pdf

2. Patriot Express: SBA Should Evaluate the Program and Enhance Eligibility Controls. GAO-13-727, September 12.
http://www.gao.gov/products/GAO-13-727
Highlights - http://www.gao.gov/assets/660/657794.pdf

3. Dental Services: Information on Coverage, Payments, and Fee Variation. GAO-13-754, September 6.
http://www.gao.gov/products/GAO-13-754
Highlights - http://www.gao.gov/assets/660/657455.pdf
Podcast: http://www.gao.gov/multimedia/podcasts/657664

4. Federal Data Transparency: Opportunities Remain to Incorporate Lessons Learned as Availability of Spending Data Increases. GAO-13-758, September 12.
http://www.gao.gov/products/GAO-13-758
Highlights - http://www.gao.gov/assets/660/657828.pdf

5. Sex Offenders: ICE Could Better Inform Offenders It Supervises of Registration Responsibilities and Notify Jurisdictions when Offenders Are Removed. GAO-13-832, September 12.
http://www.gao.gov/products/GAO-13-832
Highlights - http://www.gao.gov/assets/660/657816.pdf

Oral Health Literacy – Workshop Summary

March 7, 2013 Comments off

Oral Health Literacy – Workshop Summary

Source: Institute of Medicine

Oral health and oral health literacy are of national interest as demonstrated in the recommendations of two recent IOM reports – Advancing Oral Health in America and Improving Access to Oral Health Care for Vulnerable and Underserved Populations – as well as in the objectives of the HHS Healthy People 2020. Limited oral health literacy is associated with inaccurate knowledge about preventive measures such as water fluoridation, dental care visits, and oral health-related quality of life. The public and health care providers are largely unaware of the basic risk factors and preventive regimens for many oral diseases. Oral disease is expensive in terms of teeth, time, and money and results in pain, disfigurement, loss of school and work days, and even death when left untreated.

The IOM Roundtable on Health Literacy was interested in exploring findings from oral health literacy research and how such findings are being translated into oral health practice as well as the intersection between oral health literacy and health literacy. The roundtable held a workshop on March 29, 2012, to examine the field of oral health literacy. This document summarizes the workshop.

Human Life History Evolution Explains Dissociation between the Timing of Tooth Eruption and Peak Rates of Root Growth

January 18, 2013 Comments off

Human Life History Evolution Explains Dissociation between the Timing of Tooth Eruption and Peak Rates of Root Growth

Source: PLoS ONE

We explored the relationship between growth in tooth root length and the modern human extended period of childhood. Tooth roots provide support to counter chewing forces and so it is advantageous to grow roots quickly to allow teeth to erupt into function as early as possible. Growth in tooth root length occurs with a characteristic spurt or peak in rate sometime between tooth crown completion and root apex closure. Here we show that in Pan troglodytes the peak in root growth rate coincides with the period of time teeth are erupting into function. However, the timing of peak root velocity in modern humans occurs earlier than expected and coincides better with estimates for tooth eruption times in Homo erectus. With more time to grow longer roots prior to eruption and smaller teeth that now require less support at the time they come into function, the root growth spurt no longer confers any advantage in modern humans. We suggest that a prolonged life history schedule eventually neutralised this adaptation some time after the appearance of Homo erectus. The root spurt persists in modern humans as an intrinsic marker event that shows selection operated, not primarily on tooth tissue growth, but on the process of tooth eruption. This demonstrates the overarching influence of life history evolution on several aspects of dental development. These new insights into tooth root growth now provide an additional line of enquiry that may contribute to future studies of more recent life history and dietary adaptations within the genus Homo.

Improving Medical and Dental Readiness in the Reserve Components

June 24, 2012 Comments off

Improving Medical and Dental Readiness in the Reserve Components
Source: RAND Corporation

Describes options for Department of Defense policy that would help the reserve components of the U.S. military achieve higher levels of individual medical readiness, including dental readiness.

Selected Oral Health Indicators in the United States, 2005–2008

June 4, 2012 Comments off

Selected Oral Health Indicators in the United States, 2005–2008
Source: National Center for Health Statistics

Key findings
Data from the National Health and Nutrition Examination Survey, 2005–2008

  • More than one in five people had untreated dental caries and 75% had existing dental restorations.
  • Prevalence of untreated dental caries varied significantly by poverty level for all age groups; however, there was little difference in dental restoration prevalence by poverty level for children and adolescents aged 5–19 years.
  • Twenty-seven percent of children and adolescents aged 5–19 years had at least one dental sealant.
  • Nearly 38% of non-Hispanic black adults had not lost a permanent tooth compared with 51% for non-Hispanic white and 52% for Mexican-American persons.
  • Almost 23% of adults aged 65 and over were edentulous.

Pew: More Americans Turning To Costly Hospital Care For Preventable Dental Problems

March 1, 2012 Comments off

Pew: More Americans Turning To Costly Hospital Care For Preventable Dental Problems
Source: Pew Center on the States

Already stressed state budgets are shouldering an extra burden to cover expensive emergency room (ER) treatment for toothaches and other avoidable dental ailments, according to a new report by the Pew Center on the States. A Costly Dental Destination estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009—a 16 percent increase from 2006. Pew concludes that states can reduce hospital visits, strengthen oral health and reduce their costs by making modest investments to improve access to preventive care.

Dental-related hospital visits are fueled by the difficulty that disadvantaged people have getting regular preventive care from dentists and other types of providers. In 2009, 56 percent of Medicaid-enrolled children did not receive dental care—not even a routine exam. The access problem is driven by multiple factors, including a shortage of dentists in many areas of the U.S. and the fact that many dentists do not accept Medicaid-enrolled children.

The cost of ER care can be substantial. For example, in Florida, dental-related, emergency hospital visits produced charges exceeding $88 million in 2010. States are saddled with some of these expenses through Medicaid and other public programs.

+ Full Report

Toothbrush Can Chip Teeth and Cause Choking

February 17, 2012 Comments off

Toothbrush Can Chip Teeth and Cause ChokingSource: U.S. Food and Drug Administration

When using your electric toothbrush, you don’t expect parts of the device to pop off and chip your tooth, fly into your eyes or get stuck in your throat.

But that’s exactly what has happened to some users of the battery-powered Arm & Hammer Spinbrush—or the Crest Spinbrush, as it was called before 2009.

“It’s important that consumers know how to avoid the risks associated with using the Spinbrush,” says Shumaya Ali, M.P.H., a consumer safety officer at the Food and Drug Administration. “We’ve had reports in which parts of the toothbrush broke off during use and were released into the mouth with great speed, causing broken teeth and presenting a choking hazard.”

FDA regulates toothbrushes—whether manual or electric—as medical devices that are intended to help prevent tooth decay. Safety precautions should be taken with all kinds of electric toothbrushes.

“Electric toothbrushes can be very effective in removing dental plaque, and so they can help prevent dental decay and gum disease,” says Susan Runner, D.D.S., chief of FDA’s dental devices branch. “At the same time, it’s important to supervise children when they use these brushes, and to look out for any malfunctions of the toothbrush that might cause an injury.”

Categories: dental health, safety

Smoking and Oral Health in Dentate Adults aged 18–64

February 10, 2012 Comments off

Smoking and Oral Health in Dentate Adults aged 18–64
Source: National Center for Health Statistics

Key findings
Data from the National Health Interview Survey, 2008

  • Current smokers (16%) were twice as likely as former smokers (8%) and four times as likely as never smokers (4%) to have poor oral health status.
  • Current smokers (35%) were almost one and one-half times as likely as former smokers (24%) and more than two times as likely as never smokers (16%) to have had three or more oral health problems.
  • Current smokers (19%) were about twice as likely as former smokers (9%) and never smokers (10%) to have not had a dental visit in more than 5 years or have never had one.
  • Cost was the reason that most adults with an oral health problem did not see a dentist in the past 6 months; 56% of current smokers, 36% of former smokers, and 35% of never smokers could not afford treatment or did not have insurance.

There is a vast body of literature documenting the adverse effects of cigarette smoking on health (1–5). In 2000 the Surgeon General’s report on oral health noted that lifestyle behaviors such as smoking affect oral health as well as general health. It also emphasized the importance of oral health to overall health (6). This report examines differences among current smokers, former smokers, and never smokers in terms of oral health status, number of oral health problems, and the utilization of dental services. The study is limited to dentate adults aged 18–64.

Improving Access to Oral Health Care for Vulnerable and Underserved Populations

August 24, 2011 Comments off

Improving Access to Oral Health Care for Vulnerable and Underserved Populations
Source: Institute of Medicine

Good health requires good oral health, yet millions of Americans lack access to basic oral health care. Various factors create barriers, preventing access to care for vulnerable and underserved populations, such as children and Medicaid beneficiaries. The Health Resources and Services Administration and the California HealthCare Foundation asked the IOM and the National Research Council to assess the current oral health care system, to develop a vision for how to improve oral health care for these populations, and to recommend ways to achieve this vision.

Access to oral health care across the life cycle is critical to overall health, and it will take flexibility and ingenuity among multiple stakeholders—including government leaders, oral health professionals, and others—to make this access available. To improve provider participation in public programs, states should increase Medicaid and Children’s Health Insurance Program reimbursement rates. With proper training, nondental health care professionals can acquire the skills to perform oral disease screenings and provide other preventive services. Dental schools should expand opportunities for dental students to care for patients with complex oral health care needs in community-based settings in order to improve the students’ comfort levels in caring for vulnerable and underserved populations. Finally, states should examine and amend state practice laws to allow healthcare professionals to practice to their highest level of competence. The IOM’s recommendations provide a roadmap for the important and necessary next steps to improve access to oral health care, reduce oral health disparities, and improve the oral health of the nation’s vulnerable and underserved populations.

GP patient survey dental statistics, January to March 2011, England

June 20, 2011 Comments off

GP patient survey dental statistics, January to March 2011, England
Source: Department of Health

In the most recent quarter (January to March 2011), 1.4 million adults were asked about access to NHS dentistry in the previous 2 years. Participants were asked if they had tried to obtain an appointment with an NHS dentist and if so what was the type of appointment and had they been successful. Patients who hadn’t tried to obtain an NHS dentist in the previous 2 years were asked to select one reason why they hadn’t tried.

The results from the survey responses are presented here at national (England), Strategic Health Authority (SHA) and Primary Care Trust (PCT) level.

Main results

  • 515,000 responses, 37% of the 1.4 million people contacted
  • 60% of adults in the survey tried to obtain an appointment with an NHS dentist in the 2 year period before January to March 2011 quarter;
  • 94% of respondents who tried to obtain an appointment within the past 2 years were successful. 6% were unsuccessful (Success percentages exclude those who didn’t remember the outcome, unless stated otherwise).
  • Respondents who have tried more recently are more successful. 96% of respondents trying within the past three months and within the past six months stated they were successful.
    For 79% of adults the last appointment sought was for routine dentistry; 17% were seeking an urgent appointment, 3% other type of appointment and 1% could not remember.
  • 83% of the most recent appointments sought were with the dental practice previously attended.  In these cases, the successful percentage over the past 2 years was 96%1;
  • For the 14% of patients who sought appointments with a new dental practice in the last two years, 78% were successful, 21% were unsuccessful and 2% couldn’t remember the outcome;
  • North East SHA area had the largest percentage of the adult population seeking an NHS dental appointment in the last 2 years, at 66%, whilst South Central SHA had the smallest, where 52% sought an NHS appointment.
  • Success in getting an appointment. North East SHA had the largest percentage, with 96% successful over the last 2 years, followed by the East of England and the West Midlands both with 95%. London SHA had the lowest percentage with 92%.
  • For patients seeking an appointment in the last 2 years at a practice they had not been to before, North East had the largest percentage successful, with 86%1, North West and Yorkshire and Humber had the smallest (73% ).

Canada — Dental Care — Putting our money where our mouth is

May 16, 2011 Comments off

Putting our money where our mouth is
Source: Canadian Centre for Policy Alternatives

The renegotiations of the federal-provincial-territorial health accord are on the horizon, and everyone is looking for a way to save money and improve health. Sound impossible? Why don’t we put our money where our mouth is?

It’s a strange truth of Canadian public policy: the care of our lips, tongues, and throats is fully covered by public funding, but not our teeth and gums. This toothless approach to health care is a costly oversight for the public purse.

A mounting body of evidence shows a correlation between poor oral health and higher incidence of diabetes, cardiovascular disease, pneumonia, and Alzheimer’s. Tooth decay is a preventable by low-cost public health interventions. A coordinated approach to oral health policy could play a major role in improving health and reducing costs over the long run.

Canadians spend about $13 billion a year on our teeth. A public health program that brings dental care to kids in schools across Canada would cost about $550 million – about 4.5% of all dental spending and 0.3% of total health care spending. It would save billions of dollars of health care services down the road. An ounce of prevention really is worth a pound of cure.

Putting Our Money Where Our Mouth Is: The Future of Dental Care in Canada is a timely compendium of facts and policies that help decision makers weigh their options for cost-effective policy that can create lasting change, one healthy smile at a time.

+ Full Document

Advancing Oral Health in America

April 9, 2011 Comments off

Advancing Oral Health in America
Source: Institute of Medicine

Tooth decay is a common chronic disease in the United States and one of the most common diseases worldwide. Evidence shows that decay and other oral health complications may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes. While tooth decay is a highly preventable disease, individuals and many healthcare professionals remain unaware of the risk factors and preventive approaches for many oral diseases, and they do not fully appreciate how oral health affects overall health and well-being.

In 2009, the Health Resources Services Administration (HRSA) asked the IOM to assess the current oral health care system and to recommend strategic actions for Department of Health and Human Services (HHS) agencies to improve oral health and oral health care in America. The IOM recommends that HHS design an oral health initiative consistent with IOM’s proposed set of organizing principles, which are based on the areas in greatest need of attention and on the approaches that have the most potential for creating improvements. In addition, the IOM stresses three key areas needed for successfully maintaining oral health as a priority issue: strong leadership, sustained interest, and the involvement of multiple stakeholders.

Read full report for free online. (National Academies Press)

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