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Objectives. To assess the relationship between health care system and economic factors and early childhood caries (ECC) data availability and prevalence. Methods. We estimated ECC data for 193 United Nations countries from studies published between 2007 and 2017. We obtained other variables from the World Health Organization and the World Bank databases. We assessed association with ECC data availability by using logistic regression and with ECC prevalence by using linear regression. Results. We included 190 publications from 88 (45.6%) countries. The mean ECC prevalence was 23.8% and 57.3% in children younger than 36 months and children aged 36 to 71 months, respectively. The odds of ECC data availability were significantly higher for countries with more physicians and more dentists. In children younger than 36 months, ECC prevalence was associated with universal health coverage (B = -6.56). In children aged 36 to 71 months, it was associated with growth of gross national income (B = 0.27). Conclusions. Countries with more physicians and more dentists were more likely to have ECC data. Among those with data, countries with higher economic growth had higher ECC prevalence. [ABSTRACT FROM AUTHOR]

This article seeks to chronicle how dental therapists are being used to bolster the supply of providers for the underserved and explore their potential to diversify the field of dentistry and improve public health. Of the factors that contribute to persistent oral health disparities in the United States, an insufficient oral health workforce figures prominently. A growing number of states are authorizing amidlevel dental provider (often called a dental therapist) to address this problem. Dental therapists work under the supervision of dentists to deliver routine preventive and restorative care, including preparing and filling cavities and performing extractions. They can serve all populations in 3 states, are caring for Native Americans in an additional 3 states under federal or state authority, and are being considered in about a dozen state houses. [ABSTRACT FROM AUTHOR]

Objectives. To examine the extent to which the AIDS Education and Training Centers (AETCs) are increasing the number and racial/ethnic diversity of HIV medical providers, in accordance with the US National HIV/AIDS Strategy (NHAS). Methods. We used administrative data from funding year 2012-2013 to describe AETC trainee characteristics, including the types of medical providers trained, compared with national estimates of available US medical providers to estimate the proportion of providers trained for every 1000 available providers by professional group and race/ ethnicity. Results. AETCs trained 56 127 unique trainees, of whom 64.1% were medical providers and 45.5% were racial/ethnic minorities. Compared to national proportions, participation in AETC training was higher among racial/ethnic minorities. The proportions of racial/ethnic minority groups trained differed across regional AETCs. Conclusions. AETCs support NHAS goals by expanding the HIV medical workforce and strengthening the skills of minority medical providers to deliver high quality HIV care. Public Health Implications. Some AETCs made greater contributions to training different types of racial/ethnic minorities, which indicates varied approaches are needed to best target these efforts in communities heavily impacted by HIV. [ABSTRACT FROM AUTHOR]

Objectives. We investigated the perspectives of people using a wheelchair and their difficulties in accessing dental services. Methods. Our participatory research was on the basis of a partnership between people using a wheelchair, dental professionals, and academic researchers. Partners were involved in a committee that provided advice at all stages of the project. Our team adopted a qualitative descriptive design. Between October 2011 and October 2012 we conducted semistructured individual interviews with 13 adults who lived in Montreal, Québec, Canada, and used a wheelchair full time. We audio-recorded and transcribed verbatim interviews, and we interpreted data using an inductive thematic analysis. Results. Oral health is of heightened importance to this group of people, who tend to use their mouth as a "third hand." We identified successive challenges in accessing dental services: finding a dentist and being accepted, organizing transportation, entering the building and circulating inside, interacting with the dental staff, transferring and overcoming discomfort on the dental chair, and paying for the treatments. Conclusions. Governments, dental professional bodies, dental schools, and researchers should work with groups representing wheelchair users to improve access to dental services. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relation between Medicaid reimbursement rates and access to dental care services in the context of dentist density and dentist participation in Medicaid in each state. Methods: Data were from Early and Periodic Screening, Diagnostic, and Treatment reports for 2014, Medicaid reimbursement rate in 2013, dentist density in 2014, and dentist participation in Medicaid in 2014. We assessed patterns of mediation or moderation. Results: Reimbursement rates and access to dental care were directly related at the state level, but no evidence indicated that higher reimbursement rates resulted in overuse of dental services for those who had access. The relation between reimbursement rates and access to care was moderated by dentist density and dentist participation in Medicaid. We estimate that more than 1.8 million additional children would have had access to dental care if reimbursement rates were higher in states with low rates. Conclusions: Children who access the dental care system receive care, but reimbursement may significantly affect access. States with low dentist density and low dentist participation in Medicaid may be able to improve access to dental services significantly by increasing reimbursement rates. [ABSTRACT FROM AUTHOR]

Objectives. We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. Methods. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. Results. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Conclusions. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing). [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the relationship between dentist supply and children’s oral health and explored heterogeneity by children’s age and urbanicity. Methods. We obtained data from the 2007 National Survey of Children’s Health (> 27 000 children aged 1–10 years; > 23 000 children aged 11–17 years). We estimated the association between state-level dentist supply and multiple measures of children’s oral health using regression analysis adjusting for several child, family, and population-level characteristics. Results. Dentist supply was significantly related to better oral health outcomes among children aged 1 to 10 years. The odds of decay and bleeding gums were lower by more than 50% (odds ratio [OR] = 0.46; 95% CI = 0.23, 0.95) and 80% (OR = 0.18; 95% CI = 0.05, 0.76), respectively, with an additional dentist per 1000 population. The odds of a worse maternal rating of child’s dental health on a 5-category scale from poor to excellent were lower by about 50% in this age group with an additional dentist per 1000 population (OR = 0.51; 95% CI = 0.29, 0.91). We observed associations only for children in urban settings. Conclusions. Dentist supply is associated with improved oral health for younger children in urban settings. [ABSTRACT FROM AUTHOR]

The article discusses the authors' views about the work of the Crimson Care Collaborative group of dental students and faculty members from health professions schools which operates a weekly clinic at the Suffolk County Jail in Boston, Massachusetts, and it mentions an effort to increase availability of dental services for incarcerated patients. Enrollment in the Medicaid health insurance program is addressed, along with training for dental students in a correctional institution.

The article discusses the 2014 Mid-Maryland Mission of Mercy and Health Equity Festival (Mid-MOM) which was held at the University of Maryland's basketball arena in College Park, Maryland, and it mentions a dental clinic, public health ethics, and an effort to increase access to health and dental services. Public policy and community capacity building are examined, along with health promotion services and chronic disease risk factors. Preventive and restorative dentistry are assessed.

Objectives. We compared patient-reported receipt of smoking cessation counseling from US dentists and physicians. Methods. We analyzed the 2010 to 2011 Tobacco Use Supplement of the Current Population Survey to assess receipt of smoking cessation advice and assistance by a current smoker from a dentist or physician in the past 12 months. Results. Current adult smokers were significantly less likely to be advised to quit smoking during a visit to a dentist (31.2%) than to a physician (64.8%). Among physician patients who were advised to quit, 52.7% received at least 1 form of assistance beyond the simple advice to quit; 24.5% of dental patients received such assistance (P < .05). Approximately 9.4 million smokers who visited a dentist in 2010 to 2011 did not receive any cessation counseling. Conclusions. Our results indicate a need for intensified efforts to increase dentist involvement in cessation counseling. System-level changes, coupled with regular training, may enhance self-efficacy of dentists in engaging patients in tobacco cessation counseling. [ABSTRACT FROM AUTHOR]

Objectives. Most state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children. We examined the association between who (PCP, dentist, or both) provides these services to Medicaid enrollees before age 3 years and oral health at age 5 years. Methods. We linked North Carolina Medicaid claims (1999–2006) to oral health surveillance data (2005–2006). Regression models estimated oral health status (number of decayed, missing, and filled primary teeth) and untreated disease (proportion of untreated decayed teeth), with adjustment for relevant characteristics and by using inverse-probability-of-treatment weights to address confounding. Results. We analyzed data for 5235 children with 2 or more oral health visits from a PCP, dentist, or both. Children with multiple PCP or dentist visits had a similar number of overall mean decayed, missing, and filled primary teeth in kindergarten, whereas children with only PCP visits had a higher proportion of untreated decayed teeth. Conclusions. The setting and provider type did not influence the effectiveness of preventive oral health services on children’s overall oral health. However, children having only PCP visits may encounter barriers to obtaining dental treatment. [ABSTRACT FROM AUTHOR]

Objectives. We examined the association of smoke-free laws with dentists' advice to quit smoking and referral to a quit line, among smokers who reported visiting the dentist in the past 12 months. Methods. We used the 2006 to 2007 Tobacco Use Supplement of the Current Population Survey merged with the American Nonsmokers' Rights Foundation Local Ordinance Database of smoke-free laws. The dependent variables were advice from a dentist to quit smoking and referral to a quit line, and the independent variable of interest was 100% smoke-free law coverage. We controlled for respondent demographics and an index of state-level smoking ban attitudes (included to ensure that the effect detected was not the result of social attitudes). Results. Smoke-free law coverage was associated with dental advice to quit smoking (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.01, 1.59; P = .041), but not with referral to a quit line (OR = 1.33; 95% CI = 0.79, 2.25; P = .283). Conclusions. Interventions with dentists are needed to increase referrals to quit lines and other smoking cessation efforts. [ABSTRACT FROM AUTHOR]

Objectives. We estimated short-term health care cost savings that would result from oral health professionals performing chronic disease screenings. Methods. We used population data, estimates of chronic disease prevalence, and rates of medication adherence from the literature to estimate cost savings that would result from screening individuals aged 40 years and older who have seen a dentist but not a physician in the last 12 months. We estimated 1-year savings if patients identified during screening in a dental setting were referred to a physician, completed their referral, and started pharmacological treatment. Results. We estimated that medical screenings for diabetes, hypertension, and hypercholesterolemia in dental offices could save the health care system from $42.4 million ($13.51 per person screened) to $102.6 million ($32.72 per person screened) over 1 year, dependent on the rate of referral completion from the dental clinic to the physician's office. Conclusions. Oral health professionals can potentially play a bigger role in detecting chronic disease in the US population. Additional prevention and monitoring activities over the long term could achieve even greater savings and health benefits. [ABSTRACT FROM AUTHOR]

Objectives. We investigated general dentists' reasons for recommending removal or retention of third molars and whether patients adhered to dentists' recommendations. Methods. In a 2-year prospective cohort study (2009-2011) in the Pacific Northwest, we followed 801 patients aged 16 to 22 years from 50 general dental practices. Generalized estimating equations logistic regressions related patient and dentist characteristics to dentists' recommendations to remove third molars and to patient adherence. Results. General dentists recommended removal of 1683 third molars from 469 (59%) participants, mainly to prevent future problems (79%) or because a third molar had an unfavorable orientation or was unlikely to erupt (57%). Dentists recommended retention and monitoring of 1244 third molars from 366 (46%) participants, because it was too early to decide (73%), eruption path was favorable (39%), or space for eruption was sufficient (26%). When dentists recommended removal, 55% of participants adhered to this recommendation during follow-up, and the main reason was availability of insurance (88%). Conclusions. General dentists frequently recommended removal of third molars for reasons not related to symptoms or pathology, but rather to prevent future problems. [ABSTRACT FROM AUTHOR]

The Patient Protection and Affordable Care Act has grand ambitions: to provide insurance coverage to more than 30 million currently uninsured Americans, to slow increases in health care costs, to reorganize the health care delivery system, and to improve the quality of care provided to all. Where does the oral health community fit in this initiative? Should dentists "scope up" to become a more active part of the primary care workforce? Or should dentists "scope down" and delegate parts of the traditional dental toolkit to midlevel practitioners? Our nation's public health largely depends on whether we can create a more integrated and public health-oriented delivery system. The oral health, physical health, and public health communities should address this challenge together. [ABSTRACT FROM AUTHOR]

The dental profession is responsible for the prevention, diagnosis, and treatment of diseases and disorders of the oral cavity and related structures. Although the majority of the US population receives excellent oral health care, a significant portion is unable to access regular care. Along with proposals to develop midlevel providers, the scope of practice for dentists needs to be reconceptualized and expanded. A broad number of primary health care activities may be conducted in the dental office, such as screening for hypertension, diabetes mellitus, and dermatopathology; smoking prevention and cessation activities; and obesity interventions. More than 70% of adults saw a dentist in the past year, which represents an unrealized opportunity to improve both oral health and general health. [ABSTRACT FROM AUTHOR]

Objectives. We measured and contrasted general dentists' and periodontists' involvement in 3 areas of managing diabetic patients--assessment of health status, discussion of pertinent issues, and active management of patients--and identified and contrasted predictors of active management of diabetic patients. Methods. We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 105 of 132 eligible general dentists (response rate=80%) and from 103 of 142 eligible periodontists (response rate=73%). Results. Confidence, involvement with colleagues and medical experts, and professional responsibility were influential predictors of active management for periodontists (R²=0.46, P<.001). Variables pertaining to patient relations were significant predictors for general dentists (R²=0.55, P<.001). Conclusions. Our findings permitted us to assess and compare general dentists' and periodontists' behavior in 3 realms--assessment of diabetic patients' health status, discussion of pertinent issues, and active management of diabetic patients--and to identify components of potentially effective targeted interventions aimed at increasing specialists' and generalist dentists' involvement in the active management of diabetic patients. (Am J Public Health. 2007;97:725-730.) [ABSTRACT FROM AUTHOR]

Objectives. We conducted 5 surveys on consumer and provider perspectives on access to dental care for Ohio Head Start children to assess the need and appropriate strategies for action. Methods. We collected information from Head Start children (open-mouth screenings), their parents or caregivers (questionnaire and telephone interviews), Head Start staff (interviews), and dentists (questionnaire). Geocoded addresses were also analyzed. Results. Twenty-eight percent of Head Start children had at least 1 decayed tooth. For the 11% of parents whose children could not get desired dental care, cost of care or lack of insurance (34%) and dental office factors (20%) were primary factors. Only 7% of general dentists and 29% of pediatric dentists reported accepting children aged 0 through 5 years of age as Medicaid recipients without limitation. Head Start staff and dentists felt that poor appointment attendance negatively affected children's receiving care, but parents/caregivers said finding accessible dentists was the major problem. Conclusions. Many Ohio Head Start children do not receive dental care. Medicaid and patient age were primary dental office limitations that are partly offset by the role Head Start plays in ensuring dental care. Dentists, Head Start staff, and parents/caregivers have different perspectives on the problem of access to dental care. [ABSTRACT FROM AUTHOR]

Objectives. This study evaluated how the elimination of Medicaid reimbursement to dentists for the treatment of adult dental problems affected patients' visits to physicians. Methods. Data tapes describing physicians' claims for adult Medicaid patients were obtained from the Maryland Medicaid Management Information System. The database contains information on all claims made to Maryland Medicaid, including date, provider, International Classification of Diseases, Ninth Revision, Clinical Modification Manual code, and payments. Results. A total of 5334 individuals made physician's office claims related to dental problems sometime during the 4-year study period. The rate of dental-related claims by physicians decreased by 8% after the policy change. Conclusions. Visits to physicians' offices decreased even though an increase might have been expected because of the elimination of access to dentists in private practice. Patients might have assumed that if visits to dentists would no longer be paid for, neither would visits to physicians' offices. (Am J Public Health. 2003;93:1297-1301) [ABSTRACT FROM AUTHOR]

Objectives. This study describes the relationship between dental needs and dental care utilization among children. Methods. Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to analyze dental care needs and dental care utilization. Results. Younger children with perceived needs (needs perceived by the child or responsible adult) were more likely to be episodic users of dental care than children without perceived needs. Younger children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be regular users. Older children with perceived or normative needs were more likely to be episodic users and less likely to have had a previous-year visit than children with no needs. Conclusions. Despite their presence, dental needs do not drive dental care use among children, and children's dental care utilization is inadequate. (Am J Public Health. 2002: 92:1816-1821) [ABSTRACT FROM AUTHOR]

Objectives. This study sought to identify predictors of dental care use in HIV-infected women. Methods. In a cross-sectional survey of HIV-infected women enrolled in the northern California site of the Women's Interagency HIV Study, dental care use and unmet need were assessed in relation to selected variables. Results. Among 213 respondents, who were predominantly Black and younger than 45 years, 43% had not seen a dentist and 53% (among dentate women) reported no dental cleaning in more than a year (although 67% had dental insurance coverage, mainly state Medicaid). Nine percent were edentulous. Among nonusers of dental care, 78% reported that they wanted care but failed to get it. Barriers included fear of and discomfort with dentists, not getting around to making an appointment, and not knowing which dentist to visit. Multivariate analysis showed that lack of past-year dental care was associated mainly with unemployment, a perception of poor oral health, and edentulism. Conclusions. HIV-positive women appear to be underusing dental care services. Fear and lack of information regarding available resources, in addition to unemployment and perception of poor oral health, may be important barriers. [ABSTRACT FROM AUTHOR]

Objectives. This study investigated dentists' refusal to treat patients who have HIV. Methods. A survey was mailed to a random sample of all licensed dentists in Canada, with 3 follow-up attempts (n=6444). Data were weighted to allow for probability of selection and nonrespense and analyzed with Pearson's x2 and multiple logistic regression. Results. The response rate was 66%. Of the respondents, 32% had knowingly treated HIV-infected patients in the last year; 16% would refuse to treat HIV-infected patients. Respondents reported willingness to treat HIV-infected patients (81%), injection drug users (86%), hepatitis B virus-infected patients (87%), homosexual and bisexual persons (94%), individuals with sexually transmitted disease(s) (94%), and recipients of blood and blood products (97%). The best predictors of refusal to treat patients with HIV were lack of ethical responsibility (odds ratio = 9.0) and items related to fear of cross-infection or lack of knowledge of HIV. Conclusions. One in 6 dentists reported refusal to treat HIV-infected patients, which was associated primarily with respondents' lack of belief in an ethical responsibility to treat patients with HIV and fears related to cross-infection. These results have implications for undergraduate, postgraduate, and continuing education. [ABSTRACT FROM AUTHOR]

Objectives. Dental services the use by two cohorts under the universal dental plan for the elderly in Alberta, Canada, was examined. Methods. Two birth cohorts 65 to 69 years old at entry who used the plan from 1978 to 1979 (n = 17816). or from 1985 to 1985 (n = 27 474) wore analyzed over 6 successive years for differences in dental services use and costs. Results. The 1985/86 cohort received 24% more visits per patient than the 1978/79 cohort. Their inflation-adjusted expenditures increased by 19% mainly as result of increases in denturists' expenditures (33%) (dentists' expenditures increased just 4% because of lower plan for increases). The 1985/86 cohort received relatively many more periodontal and fewer denture services. Annual attendance over 6 consecutive years was high, especially for the 1985/86 cohort and doritists' patients; 55% of the 1985/86 cohort who used dentists did so in 5 or all 6 years. Conclusions. Differences in plan expenditures per patient between the birth cohourts and dentists and denturists, along with the high continuity o care for dentists' patients have important implications for planning and administering dental plans for the elderly. The large expenditure decreases for removable dentures and the large increases for peridontal services to the 1985/86 cohort are noteworthy. [ABSTRACT FROM AUTHOR]

All small area analyses need to compare the observed variability in rates to that expected by chance alone, but the expected variability is usually not known. This paper uses patient-level data for five dental procedures to simulate the distribution of the summary statistics that are usually generated in such studies. These statistics are found to vary greatly even under the "null hypothesis" that all dentists are using procedures at the same rates. The simulated dentist rates are compared to observed rates obtained in a different study. These findings illustrate problems that can occur in small area analysis studies, and emphasize the importance of using statistical techniques that are appropriate for the data that are to be analyzed. Investigators should make every effort to obtain patient-level data, or at least to understand the underlying distribution of the number of procedures per patient, to avoid mistaking significant deviations from an incorrect model as evidence for significant variation among small areas. [ABSTRACT FROM AUTHOR]

A study was undertaken in New York State to determine the changes in dental fluorosis prevalence from 1955 to 1986 in fluoridated Newburgh and non-fluoridated Kingston children. The frequency and severity of dental fluorosis among 884 714-year-old children were measured by two dentists utilizing Dean's Index. Data regarding residential and fluoride history were obtained from the parents of participants. Among the Newburgh residents, the prevalence of dental fluorosis (very mild to moderate) varied from a low of 5 per cent for the 9-10-year-old group to a high of 9.4 per cent for 11-12-year-olds. Except for the 13-14-year-old group, children in non-fluoridated Kingston had the lowest dental fluorosis prevalence rates. A comparison of Dean's Community Fluorosis Indices to the 1955 baseline data obtained from studies conducted after 10 years of fluoridation in Newburgh revealed no changes of consequence among Newburgh residents. However, the changes are apparent for Kingston residents, indicating the availability of fluorides in non-fluoridated areas. The increased risk for dental fluorosis for Kingston residents appears to be from the use of fluoride tablets. An analysis of dental caries data revealed that caries prevalence declined substantially in both fluoridated and non-fluoridated areas. (Am J Public Health 1989; 79:565-569.) [ABSTRACT FROM AUTHOR]

This paper explores the changing realities of dentistry in the 1970s: the development of denturism; the maldistribution of dental practitioners: the growth and activities of expanded function auxiliaries; the intrusion of the Federal Trade Commission into professional issues resulting in advertising, supermarket and franchise dentistry: and the effect of prepayment plans. These realities are considered in terms of their impact on the profession and the efforts by the individual practitioner and his representative organizations to come to terms with them. [ABSTRACT FROM AUTHOR]

In 1978, supporters of denturism in Oregon succeeded in passing an initiative which allows denturists to provide dentures directly to the public. The steps which led to the referendum included three unsuccessful attempts to have the state legislature enact a law legalizing denturism, After capturing broad-based consumer support, the issue was placed on the ballot and passed by an overwhelming margin. Both the denturists and the dentists in Oregon adopted strategies similar to those used in Canada over 20 years ago when the issue was raised in a number of provinces. As was the case in Canada, the denturists prevailed. Denturists stressed the price differential and the issue of freedom of choice. Dentists stressed health and safety issues. The public perceived the dentists' campaign as negative and self-serving. This perception may have contributed to the election results. In order to avoid this tarnished image, dentists must anticipate the public's needs, and formulate strategies to meet such needs. [ABSTRACT FROM AUTHOR]

Abstract: For the past six years, 78 dental students have worked with 25 rural dentists to provide over 31,000 dental health services to migrant patients for all of Colorado's agricultural communities. In 1977, each of 19 dental students averaged over $538 per week in value of comprehensive dental services, including preventive and peridontal services (36 per cent, N = 3,006); restorative services (46 per cent, N = 3,904); surgical services (8 per cent, N = 705); services in pulp therapy (5 per cent, N = 413); and an additional 5 per cent (N = 412) in miscellaneous services. A unique combination of federal resources from the Departments of Labor, and of Health, Education and Welfare, were combined through the Colorado State Health Department and the University of Colorado Medical Center to finance the program. Quality assurance in the program was demonstrated by: 1) a relatively low extraction to restoration ratio (1 to 5) when compared to reported studies (1 to 2); 2) a relatively low extract to root canal therapy (10 to 1) when compared to reported studies (400 to 1); 3) no statistical difference between students and rural practitioners in the quality of services as determined by peer review study. This dental program is an integrated component of a comprehensive program combining student and professional services in medicine, nursing, nutrition, and health education. [ABSTRACT FROM AUTHOR]

Abstract: Survey data were used to measure change in dental utilization in five urban low-income areas as a result of increased financial (Medicaid) and facility (community health centers) access to dental care. The average annual dental visit between the baseline and follow-up surveys showed a dramatic increase in four of the five survey areas. With the exception of Roxbury, Massachusetts, where the rate was already high in the earlier survey, the dental visit rate in the remaining areas increased 33 to 80 per cent compared to an increase of only 7 per cent nationally between 1969 and 1975. Both CHC and Medicaid programs made important contributions to increased dental care. Among persons who saw a dentist in the year in these areas, 25 per cent reported CHC as their usual source of dental care and 46 per cent reported that their dental care costs in the year were borne by Medicaid. In spite of recent increases, however, the average annual dental visit rate was only 1.0 in the five areas compared to 1.6 nationally, which is 60 per cent higher. The generally low dental utilization levels among persons covered by Medicaid or served by CHCs may indicate that much of the increased dental utilization which occurred in these areas was limited to taking care of existing dental problems while neglecting preventive dental care. (Am J Public Health 69:1001-1009, 1979.) [ABSTRACT FROM AUTHOR]

The article discusses the purposes, functions and importance of Professional Standards Review Organizations in dentistry. A comprehensive review of quality assurance in dental care and an approach to the development of standards emphasize the increasing importance of the subject to the dental profession. The author offers information about the criteria and standards necessary to assure the quality of care. The issue of posttreatment review has been particularly irksome to the profession. As dentistry is conditioned to handling only complaints, there has been major resistance to establishing an effective mechanisms to detect defective treatment of which the patient is not aware. Most dentists assume that evaluation of technical competence requires clinical examination of patients.

The author reflects on the implementation of the home health model of medical care in the U.S. She suggests that the current medical, dental and social care systems in the U.S. are difficult to navigate and create pain and suffering for older patients and burnout for care providers. She argues that the health home approach places an emphasis on promoting health and well being and that the health home model of treating older people should receive support.

The New Zealand Dental Act of 1988 allowed clinical dental technicians to deal directly with the public in fitting and supplying dentures. This study tested the hypothesis that dentists responded to competition from dental technicians by lowering their fees. The results indicate that there was no significant change in the fees charged by dentists for dentures. The apparent failure of deregulation to produce the expected outcome could be due to the competitive pressure imposed by dental technicians practicing illegally prior to 1988, to consumers' lack of information, or to barriers to "consumer search" imposed by the act itself. [ABSTRACT FROM AUTHOR]

Pediatricians, family practitioners, and dentists were questioned in the spring of 1992 about whether they counseled adolescent patients (10 through 18 years old) not to smoke. Of the 674 questionnaires distributed, 443 (66%) were returned and analyzed. Most practitioners could not estimate cigarette use among their adolescent patients. Prevention counseling occurred infrequently and least often among younger patients. Physicians were more likely than dentists to counsel adolescents. The data highlight the need for continuing training of primary health care practitioners about the importance of counseling adolescents not to smoke. [ABSTRACT FROM AUTHOR]

Surveys have shown that dentists are reluctant to treat persons infected with the human immunodeficiency virus (HIV). However, dentists are much more willing to treat patients with infectious hepatitis B virus (HBV). This study shows that the annual cumulative risk of infection from routine treatment of patients whose seropositivity is undisclosed is 57 times greater from HBV than from HIV, and that the risk of dying from HBV infection is 1.7 times greater than the risk of HIV infection, for which mortality is almost certain. [ABSTRACT FROM AUTHOR]

Proper dosage of dietary fluoride supplements is important for children without access to optimally fluoridated water to balance dental caries prevention and risks of dental fluorosis. Subsequent to water fluoride assay, compliance by physicians and dentists with the recommended dietary fluoride supplement dosage schedule was determined for 446 children. Approximately one third of child patients and 42% of siblings did not receive the recommended supplement dosage. [ABSTRACT FROM AUTHOR]

A probability sample of American general practitioner dentists, 40 years of age or older, in solo private practice, was the target of two direct mail interventions offered at two different times, to test whether knowledge regarding prophylaxis of patients at risk for infective endocarditis could be improved. Tests of knowledge were responses in a mail questionnaire to clinical vignettes, designed to elicit the content of antibiotic regimens used for patients at risk. The regimens used for patients at risk. The research design enabled detection of (1) the effect of the interventions; (2) the differences in their effect; (3) the attenuation of their effect; and (4) the effect of time. Where baseline knowledge was low, it was improved and did not rapidly disappear. Both mail interventions were equally effective, in most instances, and there was no attenuation of the interventions' effect and no effect of time on the control groups' knowledge over a 4½ month period. The results suggest that it is possible to improve clinicians' knowledge of expert recommendations through direct mail intervention. [ABSTRACT FROM AUTHOR]

Abstract: The frequencies, patterns, and results of 1,900 patient drinking water assays for fluoride content requested in a six-month period by North Carolina health professionals were determined, Twelve per ¢ of the samples warranted adjustment from the full dosage fluoride supplement. < 3 per ¢ of physicians and g per ¢ of dentists submitted samples, Water supplies should he tested before a systemic fluoride supplement is prescribed. Either few dentists and physician in North Carolina test water before prescribing supplements or few prescribe them at all. [ABSTRACT FROM AUTHOR]

Rovin and Nash suggest that alternate dental delivery systems are more competitive and will eventually capture a large share of the dental market presently held by traditional practices. The potential advantages of alternate delivery systems, mainly advertising and capitation payment, have not received careful evaluation. It is therefore premature to conclude that alternate delivery systems are structurally more competitive. [ABSTRACT FROM AUTHOR]

Abstract: A mail survey of physicians and dentists assessed their knowledge of Tel-Med; their use of it in the practice setting: and their opinion of its potential value in practice. Data suggest that both physicians and dentists regard Tel-Med's potential as high and small percentages of both groups have actually used Tel-Med in their practices. However, both groups are concerned over the potential for unsound self-diagnosis. [ABSTRACT FROM AUTHOR]