scholarly journals Oral Health in Communities and Neighborhoods (OHICAN) Pilot Project: The Burden of Poor Oral Health

2021 ◽  
Author(s):  
Charles E. Moore ◽  
Hope Bussenius ◽  
David Reznik
Keyword(s):  
Oral Health ◽  
Preventive Care ◽  
Low Income ◽  
Dental Care ◽  
Business Models ◽  
Pilot Project ◽  
Access To Dental Care ◽  
Training And Research ◽  
Oral Health Need ◽  
Health Need

Poor oral health afflicts many low-income and other vulnerable populations. Lack of access to oral health can lead to unnecessary tooth decay, periodontal disease, pain, and the advancement of oral cancer. The absence of preventive care often leads to unnecessary and expensive visits to hospital-based emergency departments to address the pain of dental disease but not the causal conditions. The consequences on inequitable access to dental care are significant for individuals, families and communities. The OHICAN pilot project looked to address the lack of equitable access to care by creating new points of access, training medical providers to perform oral exams and apply fluoride when indicated, thus increasing the oral health workforce, utilizing technology to bridge clinical practice, education, training and research, educating stakeholders to allow dental hygienists to provide preventive care under general supervision, and creating business models that will assist others who seek to create a dental home for those they serve. Social, political and economic forces all contribute to varying degrees in terms of equity in healthcare. The work of OHICAN was designed to create a blueprint for potential solutions to these issues in order to foster oral health equity. Changes to improve access to dental care can take place in a relatively short period of time when all who care and are impacted by this continued unmet oral health need work together.

Programs and Policies Targeted to Improve Access to Dental Care for Low Income Adults and Children in the US: An Integrative Literature Review

2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Davis AL ◽  
◽  
Zare H ◽  
Kanwar O ◽  
McCleary R ◽  
...  
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Literacy ◽  
Literature Review ◽  
Low Income ◽  
Dental Care ◽  
Oral Health Care ◽  
Oral Health Literacy ◽  
The Us ◽  
Access To Dental Care

Objective: The authors conducted an integrative literature review of recent studies that explored the impact of interventions implemented in the U.S. that focused on improving access to dental care for low-income and vulnerable populations. Methods: The authors conducted an integrative literature review of studies published between 2012-2018 that addressed six oral health policy spheres. 1) Community-based dental access programs; (2) Medicaid reimbursement and expansion; (3) Student loan support; (4) Oral health services in non-traditional settings and dental residency programs; (5) Programs to improve oral health literacy; and (6) Use of dental therapists. Results: The authors included 39 articles for qualitative synthesis. Numerous public health initiatives and programs exist in the US aimed at increasing access to quality oral health care. Medicaid expansion, increased Medicaid fee-for-service reimbursement rates, and state loan repayment programs have demonstrated some success in improving access among underserved populations. A diversified dental workforce, with community dental health workers and mid-level providers like dental therapists, as well as interprofessional training of nurses and primary-care physicians in oral health have also shown positive impacts in advancing health equity. Further studies are needed to understand how oral health literacy programs can affect access and utilization of dental services. Conclusions: Improvements to the oral health care safety net will require a holistic and multifaceted approach in order to reduce oral health disparities. Policy levers should work, not in isolation, but rather in complementary fashion to one another.

scholarly journals Needs-led human resource planning for Sierra Leone in support of oral health

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Swapnil Gajendra Ghotane ◽  
Patric Don-Davis ◽  
David Kamara ◽  
Paul R. Harper ◽  
Stephen J. Challacombe ◽  
...  
Keyword(s):  
Health Promotion ◽  
Oral Health ◽  
Sierra Leone ◽  
Preventive Care ◽  
Low Income ◽  
Dental Care ◽  
Oral Disease ◽  
Treatment Needs ◽  
Oral Health Promotion ◽  
Low Income Country

Abstract Background In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. Methods A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the ‘International Caries Classification and Management System (ICCMS)’ tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. Results To meet the needs of a single year-group of childrens’ needs, an average of 163 DTs (range: 133–188) would be required to deliver Conventional care (CC); 39 DTs (range: 30–45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38–68); and 27 DTs (range: 25–32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565–6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255–1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590–2236) for more extended Surgical and Preventive care (S5&6P) (range 1590–2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016–1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251–488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586–1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. Conclusion The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

scholarly journals Oral health and access to dental care among older homeless adults: results from the HOPE HOME study

2018 ◽  
Vol 79 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Daniel J. Freitas ◽  
Lauren M. Kaplan ◽  
Lina Tieu ◽  
Claudia Ponath ◽  
David Guzman ◽  
...  
Keyword(s):  
Oral Health ◽  
Dental Care ◽  
Homeless Adults ◽  
Home Study ◽  
Access To Dental Care

scholarly journals Multimorbidity and oral health: need for new models of care

2020 ◽  
Vol 8 (4) ◽  
pp. e000387
Author(s):  
Balraj Gill ◽  
Andrew Harris ◽  
Christopher Tredwin ◽  
Paramjit Gill
Keyword(s):  
Oral Health ◽  
Healthcare Systems ◽  
Models Of Care ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Ageing Population ◽  
New Models ◽  
Oral Health Need ◽  
Health Need ◽  
Robust Evidence

Multimorbidity is defined as patients living with two or more chronic health conditions. The prevalence of multimorbidity is increasing, driven by the ageing population, and represents a major challenge to all healthcare systems because these patients are heavy users of services. The link with oral health is growing although there is need for further robust evidence. There is also need for new models of care to address oral health in patients with multimorbidity.

Access to Dental Care and the Oral Health Safety Net

2013 ◽  
Author(s):  
Susan C. McKernan ◽  
Julie C. Reynolds ◽  
Astha Singhal ◽  
Raymond Kuthy ◽  
Peter C. Damiano
Keyword(s):  
Oral Health ◽  
Dental Care ◽  
Safety Net ◽  
Health Safety ◽  
Access To Dental Care

scholarly journals Exploring Variation of Coverage and Access to Dental Care for Adults in 11 European Countries: A Vignette Approach

2021 ◽  
Author(s):  
Juliane Winkelmann ◽  
Jesús Gómez Rossi ◽  
Falk Schwendicke ◽  
Antonia Dimova ◽  
Elka Atanasova ◽  
...  
Keyword(s):  
Oral Health ◽  
Health Systems ◽  
Dental Care ◽  
Cost Sharing ◽  
European Countries ◽  
Access Barriers ◽  
Financial Barriers ◽  
Out Of Pocket Payments ◽  
Access To Dental Care ◽  
The Impact

Abstract Background: Oral health has received increased attention over the past few years coupled with rising awareness on the impact of limited dental care coverage for oral health and general health and well-being. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach.Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists.Results: Completed vignettes were received from 11 countries, including Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different kinds of physical barriers to access dental care. Major access barriers to public dental care represent the limited availability of contracted dentists especially in rural areas and the unequal distribution and lack of specialised dentists.Conclusions: According to the results, statutory coverage of dental care varies across European countries while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries which in turn leads to high out-of-pocket spending. The individual socioeconomic status is thus a main determinant for access to dental care, but also other factors such as geography, age and comorbidities can inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.

Obstetric Providers' Role in Prenatal Oral Health Counseling and Referral

2019 ◽  
Vol 43 (6) ◽  
pp. 1162-1170 ◽  
Author(s):  
Alice M. Horowitz ◽  
Wendy Child ◽  
Catherine Maybury
Keyword(s):  
Oral Health ◽  
Pregnant Women ◽  
Low Income ◽  
Dental Care ◽  
Care Seeking ◽  
Educational Materials ◽  
Oral Health Literacy ◽  
Health Counseling ◽  
Qualitative Descriptive ◽  
Dental Providers

Objectives: In this study, we explored what Maryland obstetric (OB) residents and certified nurse-midwives (CNMs) know, understand, and counsel pregnant women about oral health. We also examined the frequency with which they refer patients to dentists and their perspectives on barriers to prenatal dental care. Methods: This qualitative descriptive study used one-on-one phone interviews to identify providers' perspectives about the need for prenatal dental care, reasons low-income pregnant women do not receive care, and recommendations for increasing dental care. We interviewed 32 providers between June 2017 and March 2018. Results: Most providers were unaware of the importance of and need for prenatal dental care. Most did not discuss dental care with their patients and some admitted being inadequately trained to do so. Both provider groups were positive about actions they could take to increase pregnant patients' dental care-seeking. Conclusions: For OB residents and CNMs to play an important role in improving pregnant patients' oral health they must have adequate oral health literacy, receive appropriate training in medical and nursing school, possess oral health educational materials for their patients, and have a list of dental providers who accept their insurance.

Evaluating the Effect of a Community-Based Lay Health Advisor Training Curriculum to Address Immigrant Children's Caries Disparities

2015 ◽  
Vol 49 (2) ◽  
pp. 147-156 ◽  
Author(s):  
Yuan-Jung Hsu ◽  
Wu-Der Peng ◽  
Jen-Hao Chen ◽  
Ying-Chun Lin ◽  
Chin-Shun Chang ◽  
...  
Keyword(s):  
Oral Health ◽  
Dental Care ◽  
Oral Hygiene ◽  
Health Knowledge ◽  
Immigrant Women ◽  
Self Report ◽  
Training Curriculum ◽  
Lay Health Advisor ◽  
Access To Dental Care ◽  
Medically Underserved Population

Previous programs had not designed the culturally adequate Lay Health Advisor (LHA) oral health training curriculum for medically underserved population. We evaluated the effects of LHA training curriculum for addressing immigrant children's caries disparities in their access to dental care. We used a pre/post-test study design. Immigrant women were recruited from churches, schools, and immigrant centers in an urban area. Four training classes were held. Each training cycle lasted 15 consecutive weeks, consisting of 1 weekly 2-h training session for 12 weeks followed by a 3-week practicum. The curriculum included training in caries-related knowledge, oral hygiene demonstrations, teaching techniques, communication skills, and hands-on practice sessions. Thirty-seven LHA trainees completed the course and passed the post-training exam. The data were collected using self-report questionnaires. The level of oral health knowledge, self-efficacy and attitudes toward oral hygiene were significantly increased after LHA training. There was a significant and over twofold increase in trainees' oral hygiene behaviors. An increase of >20% in LHA and their children's dental checkup was observed following training. After training, LHAs were more likely to have 3+ times of brushing teeth [Odds Ratio (OR) = 13.14], brushing teeth 3+ minutes (OR = 3.47), modified bass method use (OR = 30.60), dental flossing (OR = 4.56), fluoride toothpaste use (OR = 5.63) and child's dental visit (OR = 3.57). The cross-cultural training curriculum designed for immigrant women serving as LHAs was effective in improvement of oral hygiene behaviors and access to dental care.

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