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Objectives: This study aimed to update dental service utilization during pregnancy and to evaluate whether there are persistent disparities in dental care during pregnancy by race/ethnicity and Medicaid status. Methods: This retrospective secondary data analysis examined dental service utilization during and prior to pregnancy and met dental or oral health needs using the Pregnancy Risk Assessment Monitoring System (PRAMS) data sets on 75,876 women between 2012 and 2015. Results: Only about half of the women (51.7%) reported that they had at least 1 dental visit for cleaning during their most recent pregnancy. One of 5 women (19.7%) experienced dental problems during pregnancy, and 34.4% of these women did not visit dentists to address the problems. Non-Hispanic Black women had 14% lower odds of visiting dentists for cleaning during pregnancy compared to non-Hispanic White women (odds ratio [OR], 0.86; 95% CI confidence interval [CI], 0.80–0.92). There was no difference in dental visits prior to pregnancy between non-Hispanic Black and White women. Women enrolled in Medicaid showed significantly lower odds of visiting dentists for cleaning during pregnancy compared to women covered by private health insurance (OR, 0.55; 95% CI, 0.52–0.58). Conclusion for Practice: Oral health, as an integral part of primary care, needs to be included in the standard prenatal care through oral health education and timely dental care during pregnancy. With mounting evidence of persisting disparities in dental service utilization during pregnancy, both public and private prenatal programs and policies should address specific barriers in accessing and using dental care during pregnancy, especially for women from socially disadvantaged backgrounds. Knowledge Transfer Statement: The current study updated the previous findings with more recent multiyear PRAMS data (2012–2015) and found the Black-White disparity and disparity among Medicaid-enrolled women in visiting dentists during pregnancy persist. The results of this study can be used by policymakers and practitioners to integrate oral health into prenatal care for pregnant women from marginalized backgrounds to achieve oral health parity.

Objectives Dental-related emergency department (ED) visits are a growing public health concern. Dental insurance coverage is a strong predictor of dental service access. The objective of this study was to conduct a systematic review to assess the incidence of dental-related ED visits for Medicaid dental enrollees compared to those with other insurances. Methods PubMed, EMBASE, and Google Scholar were searched for surveillance and observational data published in English from January 1999 to April 2020 to address the following PECOT question: Do patients with nontraumatic dental conditions (NTDC) (P1), or patients with any dental condition (P2) who have Medicaid (E) compared to other insurance status (private insurance, Medicare, no insurance) (C) have a differential incidence of single dental-related ED visits (O) in the literature search results from 1999 to April 2020 (T)? A critical appraisal was performed using a combination of the AXIS tool (for cross-sectional studies with observational data and MetaQAT (for public health evidence). Results This systematic review included 32 studies. Overall, risk of bias was low. Due to significant statistical heterogeneity, a synthesis without meta-analysis was conducted. NTDC ED visits ranged from 16.0 percent to 79.8 percent for Medicaid patients and 0.9 percent to 57.2 percent for uninsured patients. The range for any dental visit to the ED was 2.2-63.8 percent for Medicaid patients and 2.9-40.8 percent for uninsured patients. Conclusions The results of this study support expanding insurance coverage in Medicaid programs to reduce ED use for NTDC visits in the United States.

Background: Efforts to combat the spread of COVID-19 have led to guidance to restrict dental practice to treating emergency and urgent dental visits and reduce or eliminate elective dental procedures. Better understanding of the frequency of dental emergencies and the procedures performed during those emergency visits can help providers, insurers, and policymakers understand workforce and care provision needs.Methods: Procedures performed at an emergency dental encounter and in the encounter following that encounter are assessed. Emergency dental encounters are those with a CDT code of D0140, D0160, or D0170. Data was analyzed from the IBM Watson Medicaid Marketscan data from 2013 to 2017, a nationally representative dental and medical claims database from 13 deidentified states.Result: Consistently over time, about 10% of all dental encounters are due to a dental emergency. 28% of emergency dental encounters had no other procedure performed during those encounters. When other procedures were performed during the encounter, the majority were diagnostic in nature, primarily radiographs. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, most within 30 days. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, with the majority returning within 30 days for that treatment.Conclusions: The majority of dental emergency encounters do not result in definitive treatment, rather patients often return to the dentist at a later date for that treatment. Where possible, dental providers could utilize teledental services to triage patients to appropriate care.

Background: The objective of this retrospective cohort study is to examine the determinants of tooth loss in a Medicaid-enrolled population using claims data from 2016 to 2018. Methods: Deidentified administrative claims data for Medicaid-enrolled adults between the ages of 50 and 90 y in 2016 to 2018 were examined using the IBM Watson MarketScan Medicaid Database. The sample size was 91,468. The entire sample was divided into 2 cohorts: no tooth loss cohort (n = 54,786) and tooth loss cohort (n = 36,682). The tooth loss cohort was further divided into 2 groups: 1 to 5 teeth lost (n = 29,141) and 6 or more teeth lost (n = 7,541). Tooth loss was described by age, gender, race, number of commodities, and if periodontal treatment was performed. Logistic regression models were conducted to examine factors associated with tooth loss. Results: Within the tooth loss cohort, the patients who had periodontal treatment had higher odds of losing at least 1 tooth (odds ratio [OR], 1.15; confidence interval [CI], 1.10–1.20) and lower odds of losing 6 or more teeth (OR, 0.25; CI, 0.22–0.29). In the regression analysis, the predictive margins of tooth loss for 1 tooth and 6 or more teeth follow a linear path. Compared to no comorbidities, the odds of losing 6 or more teeth increased with 1, 2, or 3+ comorbidities. Knowledge Transfer Statement: This study provides significant information about the quantification of comorbidities and its direct correlation with the increased odds of tooth loss. This study also highlighted the protective effect of periodontal treatment on tooth loss. This knowledge can be useful to dental care providers to understand the risk of tooth loss in their patient population.

ObjectiveTo examine the use of Medicaid, commercial claims, and self-reported survey data to estimate the prevalence of oral disease burden.MethodsWe analyzed 2018 Medicaid claims from IBM Watson Medicaid Marketscan database, commercial claims from the IBM Dental Database, and Medical Expenditure Panel Survey (MEPS) data. The estimate of oral disease burden was based on standard metrics using periodontal and caries-related treatment procedure codes. Examples are restorations: D2000-D2999, root Canals: D3230 – D3334, periodontics: D4000 – D4999, prosthodontics: D5000 – D6999 and extractions: D7000 - D7251. A direct comparison between the data sets was also done. Enrollees from the different databases were broken down by gender, race/ethnicity, and into age groups.ResultsMedicaid and commercial enrollees were 11.6 million and 10.5 million. The weighted proportion from MEPS for Medicaid and commercial plans ranged from 80-208 million people. Prevalence of caries-related treatments was estimated for IBM Watson and MEPS for total enrollees for Medicaid (13% vs. 12%); and commercial claims (25% vs. 17%), respectively. Prevalence of periodontal related treatments was estimated for IBM Watson and MEPS total enrollees for Medicaid (0.7% vs. 0.5%) and commercial claims (7% vs. 1.6%), respectively. Prevalence of dental diseases was higher in patients with at least one visit for Medicaid, commercial plans, and MEPS. Prevalence based on specific procedures were higher in commercial plans than in Medicaid.ConclusionsClaims data has the potential to serve as a proxy measure for the estimate of dental disease burden in a population. In addition, in rare events, claims data provides a better estimate of disease burden because it is based on a larger dataset.

Objective The aim of this study was to examine the effect of Medicaid expansion on non-traumatic dental condition (NTDC) emergency department visits in New York (NY) and New Jersey (NJ). Methods The 2010-2014 State Emergency Department Databases for NY and NJ were analyzed. NTDCs were defined as ICD-9-CM codes 520.0-529.9. Primary payers for ED discharges and patient's race were considered. Results In NY, from 2010 to 2011, there was a 51 percent decrease in private insurance and a 91 percent increase in Medicaid for NTDCs. In NJ, with the 2014 expansion, NTDCs fell 35 percent for uninsured and rose 57 percent for Medicaid. Black individuals have by far the highest population rates of NTDC ED visits, particularly in NJ. Conclusions The experiences in NY and NJ suggest that the timing of expansion had significant effects on payer distribution for NTDCs. Racial disparities continue exist with black individuals disproportionately accessing EDs for NTDCs.

This study evaluated the impact of well-child visits (WCVs) on promoting preventive visits to the dentist. Effects by age, race, gender, and dental diagnosis were investigated.Administrative claims data for 1.85 million Medicaid-enrolled children aged 4 or less in 13 states in 2013 were identified from the Truven MarketScan Medicaid Database. A cohort for all children who had a WCV in 2013 was generated and followed for 365 d to identify the date of closest preventive dental visit.The cohort included 1,308,719 Medicaid-enrolled children with a WCV in 2013. Three percent of children under the age of 1 with a WCV had an oral health assessment within 1 y compared to only 0.4% of all Medicaid-enrolled children in that age group. Similar patterns were seen in all age groups: age 1 (13% vs. 9%), age 2 (32% vs. 23%), age 3 (50% vs. 37%), and age 4 (59% vs. 48%). On average, about 1.4% of children received an oral health assessment during their WCV, and another 0.6% were diagnosed with a dental condition. These children had a higher proportion of visits to the dentist for a preventive visit after a WCV. Children of all races (White, Hispanic, and Black) with a prior WCV had higher preventive dental compared to total enrolled. However, Hispanic children with a WCV reported the highest preventive dental visits within 1 y (White 24%, Black 29%, and Hispanic 46%). Furthermore, Hispanic children visited the dentist earlier than White and Black children; 16.9% of Hispanic children visited the dentist within 90 d of the WCV compared to 8.5% of White and 10% of Black children.This study demonstrated increased utilization of dental preventive visits for the children who received a well-child visit.Results of this study indicate a higher number of preventive dental visits for children with prior WCV. Clinical implications of this study would be to continually increase and promote the inclusion of oral health within primary care. This can increase the likelihood of preventative dental visits and, ultimately, better dental health in children.

Studies have shown that mental health and oral health may be correlated, with associations demonstrated between mental health problems and tooth loss, periodontal disease, and tooth decay. The COVID-19 pandemic had alarming implications for individuals' and communities' mental and emotional health. This study examined the associations between mental health status, oral health status, and oral healthcare utilization and highlighted the impact of COVID-19 on mental health. Additionally, this study examines specific sociodemographic factors that may amplify oral health disparities. A nationally representative survey was conducted to capture attitudes, experiences, and behaviors related to oral health, mental health, and unmet oral health needs. Eighteen percent of respondents were categorized as having poor mental health. Visiting the dentist in the last year was more common amongst individuals with good mental health. From the logistic regression model, mental health status, age group, race/ethnicity, education, and last dental visit were all significantly associated with of oral health status. Mental health status, age group, and income groups were all significantly associated with unmet oral health need. Future work should focus on the mental-oral health association, including determining ways to improve oral healthcare utilization and oral health status among people with poorer mental health.

Background: Life course theory creates a better framework to understand how oral health needs and challenges align with specific phases of the lifespan, care models, social programs, and changes in policy. Methods): Data are from the 2018 IBM Watson Multi-State Medicaid Marketscan Database (31 million claims) and the 2018 IBM Watson Dental Commercial and Medicare Supplemental Claims Database (45 million claims). Analysis compares per enrollee spending fee-for-service dental claims and medical spending on dental care from ages 0 to 89. Results: Dental utilization and spending are lower during the first 4 years of life and in young adulthood than in other periods of life. Stark differences in the timing, impact, and severity of caries, periodontal disease, and oral cancer are seen between those enrolled in Medicaid and commercial dental plans. Early childhood caries and oral cancer occur more frequently and at younger ages in Medicaid populations. Conclusions: This unique lifespan analysis of the U.S. multi-payer dental care system demonstrates the complexities of the current dental service environment and a lack of equitable access to oral healthcare. Practical Implications: Health policies should be focused on optimizing care delivery to provide effective preventive care at specific stages of the lifespan.

BackgroundWe examine trends in opioid prescriptions by dentists for Medicaid-enrolled children and non-senior adults.MethodsWe utilized the IBM Watson Medicaid claims databases for 2012-2019 and the CDC conversion dataset. Opioid prescriptions were linked to a dental visit when prescribed within three days of the dental visit and if the patient had no medical visit reported during that period. We conducted descriptive analyses for age, procedures performed, treatment history, and prescription strength.ResultsOur study showed consistent decreases in opioid prescription rates in dentistry during the study period: from 2.7% to 1.6% among children (0-20), and from 28.6% to 12.2% for adults (21-64). The adult opioid prescription rate fell for nonsurgical dental procedures from 9.7% to 2.9%. For surgical procedures, the adult prescription rate fell from 48.0% to 28.7%. Most dental-related opioids were prescribed for oral surgeries (Children: 70.8%, Adults: 58.6%). By 2019, 23% of all opioid prescriptions for children were dental related.ConclusionWe found that opioid prescription rates in dentistry for Medicaid enrollees declined significantly between 2012 and 2019 for both children and adults. The percent of prescriptions written for nonsurgical visits consistently declined over the observed timeframe. At the same time, opioid prescription rates for both dental surgical procedures and dental nonsurgical procedures decreased as well.Practical ImplicationsAlthough the trends revealed in our analysis show declining opioid prescription patterns, these results suggest that the overall rate is still too high and prescriptions are being written unnecessarily.

Recent emphasis has been placed on the integration of dental and medical primary care in an effort to promote recommendations from both American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) that highlight the importance of preventing, intervening, and managing oral disease in childhood. The study aims to provide a population level insight into the role of location of service of medical well-child visit (WCV) and its association to preventative dental visit (PDV) for children between the ages of 0–20 years. Administrative claims data for 3.17 million Medicaid-enrolled children aged 0 to 20 years of age in 13 states in 2016 and 2017 were identified from the IBM Watson MarketScan Medicaid Database. Descriptive and survival analysis reveals most Medicaid enrolled children receive their WCV at an office and hospital, as compared to federally qualified health center, or rural or public health clinic. Further, this study demonstrates increased utilization of dental preventive services for children who receive a WCV. Hispanic children, female children, and children 5–9 years of age had a higher rate of PDV after a WCV at all three locations. This study contributes to the understanding of medical-dental integration among Medicaid-enrolled children and offers insight into the promotion of oral health prevention within medical primary care.

Background Silver diamine fluoride (SDF) is a minimally-invasive preventive service used in the U.S. to avert and arrest caries since 2014. No studies document survival outcomes based in real world delivery. We analyzed 12-month survival outcomes of SDF applied independently or concurrently with other restorative procedures among a population receiving community dental care. Methods We analyzed data on SDF applications from de-identified dental claims on Oregon Health Plan patients served by Advantage Dental in 2016, who had been seen in 2015 (patient n = 2269; teeth n = 7787). We compared survival rates of SDF alone, SDF applied with a sedative filling, and SDF with a same-day restoration. Failure was defined as a restoration or extraction of the tooth 7 to 365 days after initial application. Survival was defined as a patient returning 180 or more days after application whose tooth did not have a restoration or extraction. Differences were assessed through Wilcoxon equality of survivor function tests and log-rank equality of survivor tests to compare failure rates, Cox Proportional Hazards models to assess factors associated with survival of SDF, and Kaplan–Meier survival estimate to calculate the probability of survival over time. Results SDF alone had an overall survival rate of 76%. SDF placed with sedative filling and with a same-day restoration had survival rates of 50% and 84% respectively, likely reflecting treatment intent. SDF alone survived exceptionally well on primary cuspids, permanent molars, and permanent bicuspids and among patients aged 10 to 20 years, with modest variation across caries risk assessment categories. A single annual application of SDF was successful in 75% of cases. Among SDF failures on permanent dentition, more than two-thirds of teeth received a minor restoration. Conclusion SDF is a minimally invasive non-aerosolizing option that prevented non-cavitated lesions and arrested early decay among community dentistry patients when applied independently or concurrently with restorative procedures. Professional organizations, policy makers, providers, and payors should broaden optional SDF use by informing clinical guidelines, reimbursement policies, and treatment decisions. Future research should address clinical, social, service delivery, workforce, and economic outcomes using diverse population-based samples, and the mechanisms underlying single application success and caries prevention potential.

Background The authors examined trends in opioid prescriptions by dentists for children and nonsenior adults enrolled in Medicaid. Methods The authors used the IBM Watson Medicaid claims databases for 2012 through 2019 and the Centers for Disease Control and Prevention conversion data set. Opioid prescriptions were linked to a dental visit when prescribed within 3 days of the dental visit and if the patient had no medical visit reported during that period. The authors conducted descriptive analyses for age, procedures performed, treatment history, and prescription strength. Results The results of the study showed consistent decreases in opioid prescription rates in dentistry during the study period from 2.7% to 1.6% among children (aged 0-20 years) and from 28.6% to 12.2% for adults (aged 21-64 years). The adult opioid prescription rate decreased for nonsurgical dental procedures from 9.7% to 2.9%. For surgical procedures, the adult prescription rate decreased from 48.0% to 28.7%. Most dental-related opioids were prescribed for oral surgeries (children, 70.8%; adults, 58.6%). By 2019, 23% of all opioid prescriptions for children were dental related. Conclusions The authors found that opioid prescription rates in dentistry for people enrolled in Medicaid declined substantially from 2012 through 2019 for both children and adults. The percentage of prescriptions written for nonsurgical visits consistently declined over the observed time. During the same time, opioid prescription rates for both dental surgical procedures and dental nonsurgical procedures decreased as well. Practical Implications Although the trends revealed in the analysis show declining opioid prescription patterns, these results suggest that the overall rate is still too high and prescriptions are being written unnecessarily.

Objective There are both opportunities and challenges with the implementation of oral health value-based care (OHVBC). To tackle concerns and advance conversation, a symposium was convened with subject matter experts to develop a gap analysis and capture insights into professional readiness for value-based care design. Methods The symposium was convened as a private event for 46 participants over the course of one and a half days in December 2019. Thematic analyses utilized the OHVBC Readiness Framework (DentaQuest Partnership, 2019) to further codify conversations as part of the gap-analysis process. Poll Everywhere, a text messaging application that allows participants to answer questions in real time, was also employed to solicit responses. Results Attendees of the symposium felt that OHVBC would have a large portion of market share within the next 10 years. A qualitative assessment of multiple table discussions determined that the participants developed more consensus around themes for the current state and the future-desired state than the action-planning needed to close the gap between the two. This may relate to individual ideology, and the siloed environment is still prevalent in the oral health realm. In a postsymposium survey, respondent attendees did not perceive that COVID-19 would delay or negatively impact the adoption of OHVBC and may result in accelerating its utilization. Conclusion The oral health community is experiencing multiple drivers to adopt more OHVBC within business and care models. However, there is still a lack of uniformity on how to execute this delivery model.

To determine whether the length, dose, and/or frequency of opioid prescriptions correlates with the subsequent diagnosis of opioid use disorder (OUD) among Medicaid enrollees and if there are higher odds of developing opioid dependence after receiving opioid prescriptions for dental procedures versus medical procedures. Our design was a nested case‐control in a cohort of continuously enrolled, opioid‐naive (no opioid prescription for 1 year before the first prescription of opioid) Medicaid enrollees with at least one opioid prescription between January 1, 2013, and December 31, 2017, in IBM Watson Health’s MarketScan Medicaid database. The cases were defined as enrollees with diagnosed opioid use disorder, and controls were drawn from the same population who were not diagnosed with OUD. They were matched (up to 1:2) by age, sex, race, baseline pain diagnosis, number of Elixhauser comorbidities, and similar exposure time for prescription opioids. Outcome variable was the diagnosis of OUD, and the predictor variables were cumulative length of opioid prescriptions, morphine milligram equivalent (MME) dose, and frequency of opioids. The correlation was explored through multivariate logistic regression, and the model was re‐adjusted for baseline matching characteristics. The study population is opioid‐naive Medicaid enrollees with at least one opioid prescription between January 1, 2013, and December 31, 2017, in IBM Watson Health’s MarketScan Medicaid database. Among a matched cohort of 1051 cases and 2053 controls, odds of OUD increased significantly for prescription count of 2‐3 (OR = 1.3, CI = 1.1‐1.6), 4‐5 days (OR = 2.0, CI = 1.4‐2.8), and above 6 (OR = 5.1, CI = 3.3‐7.8), compared to one prescription. Odds of OUD increased significantly for cumulative prescription length of 31‐60 days (OR = 1.8, CI = 1.3‐2.3), 61‐90 days (OR = 2.9, CI = 1.5‐5.6), and above 91 days (OR = 10.1, CI = 5.0‐20.4), compared to 5 days or less. Odds of OUD for average prescription length of 16‐30 days (OR = 1.9, CI = 1.3‐2.5) were significantly more compared to 5 days or less. Odds of OUD increased significantly for cumulative MME dose of 120‐180 (OR = 1.7, CI = 1.2‐2.3), and for 180 and above (OR = 4.1, CI = 2.8‐5.8), compared less than or equal to 20. Odds of OUD for average MME dose of 91 and above (OR = 1.9, CI = 1.2‐3.0) were significantly more compared less than or equal to 20. Moreover, enrollees who received opioid prescription for dental procedure were less likely (OR = 0.5, CI = 0.4‐0.7) to develop OUD then who received prescriptions for medical procedures. The study concluded that when number of prescriptions, days supplied, and morphine milligram equivalent dose go up, the odds of developing OUD increases significantly. Therefore a quantitative association between prescription opioid exposure and subsequent dependence in established. Moreover, the odds of developing OUD are less for prescriptions received after dental procedures compared to medical procedures. The study informs the opioid prescribing and opioid‐prescribing guidelines for clinical practice. DentaQuest Partnership for Oral Health Advancement.

Dental caries are the most common chronic disease of childhood. Untreated caries can result in severe pain and infection; and in some cases, difficulties in eating, speech, and education. Hospitalization and general anesthesia are often necessary for treating extensive disease in young children, which adds significant risk and expense. Interventions, such as community-based preventative care, utilization of pre-authorizations for treatment, and at-risk contracts, have been deployed as innovative strategies to reduce the incidence of caries and the cost of treatment. Value-based payment structures give payors flexibility to design a multipronged system to impact the health of consumers. This practice brief will identify interventions at a systems level that reduced the utilization of general anesthesia treating dental caries in children under the age of six. Dental claims data from the period of Q1 2011 to Q2 2020 were utilized to analyze the trends in utilization of the operating room (OR) to treat dental conditions among children under 6 years. Fixed effects analysis was utilized to identify key over time changes in the reduction of children's OR utilization. A reduction in utilization of general anesthesia and hospitalization for treating dental caries in young children was seen. The expansion of the community care team, metrics to reinforce the systems of provider education and training, and the use of incentive payments were all associated with reductions in the rate of OR utilization. Between 2012 and 2017, multiple initiatives were implemented without a systematic approach to quality improvement to evaluate.