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To compare the use of Medicaid and commercial claims data with self-reported survey data in estimating the prevalence of oral disease burden.We analyzed 2018 Medicaid claims from the 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 Current Dental Terminology (CDT) procedure codes. A direct comparison between the data sets was also done.Unweighted Medicaid and commercial enrollees were 11.6 and 10.5 million, respectively. The weighted proportion from MEPS for Medicaid and commercial plans ranged from 80 to 208 million people. Estimates of caries-related treatments were calculated from IBM Watson and MEPS data for Medicaid enrollees (13% vs. 12%, respectively) and commercial claims (25% vs. 17%, respectively). Prevalence of periodontal related treatments for those with a dental visit was estimated for IBM Watson and MEPS enrollees for Medicaid (0.7% vs. 0.5%, respectively) and commercial claims (7% vs. 1.6%, respectively). Dental disease estimates were higher in individuals with at least one dental visit across cohorts. Prevalence of disease for those with a dental visit based on specific procedures were higher in commercial plans than in Medicaid.Claims data has the potential to serve as a proxy measure for the estimate of dental disease burden in a population.

The aim of this study is to (1) examine the prevalence of human papillomavirus (HPV) vaccination in adolescents and young adults in the U.S., including those who had a dental visit in the last year but not a medical visit and (2) to determine an association between last visit to the dentist and HPV vaccination status.We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey from 2015 to 2018, including participants 9-26 years. Descriptive statistical analyses were conducted to characterize the study population and calculate the prevalence of HPV vaccination in adolescents and young adults, including those who had a dental visit in the last year but not a medical visit. Logistic regression analyses were performed to examine the association between last visit to the dentist and HPV vaccination status.In total, 38.6% of participants were vaccinated for HPV, with higher prevalence of vaccination in those with the following characteristics: female, older age, higher income, higher education level, and having medical insurance. Participants who had a dental visit in the last year had an HPV vaccination rate of 40.8%. Of those who had a dental visit and were not vaccinated for HPV, 12.5% did not have a medical visit. Having a dental visit in the last year increased the odds of being vaccinated for HPV (odds ratio 1.69, confidence interval 1.26-2.28).Dentists see a significant number of adolescents and young adults who are unvaccinated for HPV in a given year and could serve as an access point for HPV vaccine delivery in the future.

To ascertain the financial impact associated with the underutilization of preventive dental care for adults enrolled in Medicaid.We used adult claims data for patients aged 21-64 in the IBM Watson Marketscan Medicaid database. Enrollees were included if they had at least one dental claim in 2019 and were continuously enrolled between 2014 and 2019. We then evaluated the costs of their dental care in 2019, based on the number of years of preventive dental care they received between 2014 and 2018. We also assessed Emergency Department (ED) utilization for dental conditions, oral surgeries, and dental-related opioid prescriptions.The average Medicaid enrollee with five continuous years of preventive care prior to 2019 experienced 43% lower costs than an individual who received no preventive dental care at all. Most of the savings were a result of fewer oral surgeries. A Medicaid enrollee with no preventive dental visits was eight times more likely to have an ED visit for a nontraumatic dental condition (NTDC), seven times more likely to have oral surgery and six times more likely to receive a dental-related opioid prescription compared to those who had a dental prevention visit every year in the 5-year lookback period.Regular preventive dental care in the lookback period was associated with significant savings in overall dental care costs when compared to dental care costs for those individuals who received no or few preventive visits. Prior preventive dental care was also associated with lower rates of ED-NTDC utilization, oral surgery, and dental-related opioid prescriptions.

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.

BackgroundDental caries remains a global problem that causes disproportionate suffering in underserved populations. Simple interventions are needed to improve patient experience, clinical and cost-effectiveness, and access to care. The self-assembling peptide P11-4 is a recently developed, non-invasive treatment that regenerates enamel in initial caries lesions.Studies reviewedWe conducted a systematic review and meta-analysis on the effectiveness of the P11-4 products Curodont™ Repair (CR) and Curodont™ Repair Fluoride Plus (CRFP) on initial caries lesions. Primary outcomes were lesion progression after 24 months, caries arrest, and cavitation. Secondary outcomes were changes in merged International Caries Detection and Assessment System (ICDAS) score, Quantitative Light Fluorescence, esthetic appearance, and lesion size.ResultsSix clinical trials comparing CR to controls met the inclusion criteria. Results of this review represent two primary and two secondary outcomes. When compared to parallel groups, CR improved caries arrest (RR: 1.82; 95% CI: 1.32 to 2.50; 45% attributable risk; 95% CI: 24 to 60%) and decreased lesion size by 32% (Hedge’s g: -0.59; CI: -1.03 to -0.15). We observed positive trends for avoiding cavitation (RR: 0.32; CI: 0.10 to 1.06) and lowering merged ICDAS score (RR: 3.68; CI: 0.42 to 32.3). No studies used CRFP or reported adverse esthetic changes.Practical implicationsCR has a treatment effect on caries arrest and decreased lesion size. Two trials contributing to the caries arrest result had non-masked assessors, and all trials had elevated risks of bias. We recommend conducting longer trials. CR is a promising treatment for initial caries lesions.

Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice.This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines).Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.

Nonventilator hospital-acquired pneumonia is associated with substantial morbidity, mortality, and costs during an episode of acute care. We examined NVHAP incidence, mortality, and costs of Medicaid beneficiaries over a 5-year period (2015-2019). Overall NVHAP incidence was 2.63 per 1,000 patient days, and mortality was 7.76%, with an excess cost per NVHAP case of $20,189.

People who are poor or members of communities of color face inequitable oral disease burden. Continued separation of dental and oral health from general medical care exacerbates inequity and forces members of underserved communities to seek nontraumatic dental emergency care in hospital emergency departments. This trend is unnecessarily costly and results in antibiotic prescriptions and pain management that are neither restorative nor responsive to patients' primary complaints. Value-based approaches to health care need to unify mouth care with general medical care, motivate medical-dental interprofessional practice, promote oral disease prevention, and support restorative dental care. Value-based approaches to health care must also innovate fiscal structures (eg, payment models, data sharing) to improve health outcomes for everyone.

Background: This study compared prevalence, incidence, mortality rates, treatment costs, and risk factors for oral and oropharyngeal cancer (OC/OPC) between two large United States adult cohorts in 2012–2019. Methods: Medicaid and commercial claims data came from the IBM Watson Health MarketScan Database. Logistic regression analyses estimated incidence and risk factors for OC/OPC. Mortality was calculated by merging deceased individuals’ files with those of the existing cancer cohort. Summing costs of outpatient and inpatient services determined costs. Results: Prevalence of OC/OPC in Medicaid enrollees decreased each year (129.8 cases per 100,000 enrollees in 2012 to 88.5 in 2019); commercial enrollees showed a lower, more stable prevalence (64.7 per 100,000 in 2012 and 2019). Incidence trended downward in both cohorts, with higher incidence in the Medicaid (51.4–37.6 cases per 100,000) than the commercial cohort (31.9–31.0 per 100,000). Mortality rates decreased for Medicaid enrollees during 2012–2014 but increased in the commercial cohort. OC/OPC treatment costs were higher for commercial enrollees by $8.6 million during 2016–2019. OC/OPC incidence was higher among adults who were older, male, and white; used tobacco or alcohol; or had prior human immunodeficiency virus/acquired immune deficiency syndrome diagnosis and lower among those who had seen a dentist the prior year. Conclusions: Medicaid enrollees experienced higher OC/OPC incidence, prevalence, and mortality compared with commercially insured adults. Having seen a dentist within the prior year was associated with a lower risk of OC/OPC diagnosis. Impact: Expanding Medicaid dental benefits may allow OC/OPC to be diagnosed at earlier stages through regular dental visits.

Background COVID-19 disrupted dental service delivery and revealed gaps in dental pandemic emergency preparedness and response (PHEPR). Emerging dental PHEPR frameworks can be strengthened by understanding the experiences of the discipline’s frontline workers—dental safety net providers—during the initial phase of the COVID-19 pandemic. Methods Experienced qualitative researchers interviewed safety net dental directors and clinicians (n=21) in six states to understand their experiences delivering services between March 2020 and February 2021. Interview transcriptions were analyzed using iterative codes to identify major and minor themes. Conventional qualitative validity checks were continuously utilized to ensure impartiality and rigor. Results Three major themes were identified. (1) Unpredictability caused concerns among staff and patients, while also deepening fulfilling collaborations. (2) Service delivery was guided by various resources that balanced safety, flexibility, & respect for autonomy. (3) Pandemic-driven changes to oral health service delivery are timely, long-lasting, and can be somewhat fraught. Conclusions The human, material, and policy resources that providers used to control infections, serve vulnerable patients, maintain clinic solvency, and address provider burnout during COVID-19 pandemic year one can improve dental PHEPR. Practical Implications Dental PHEPR should address concerns beyond infection control within and between practice models, governmental agencies, and professional organizations. Examples of such concerns include, but are not limited to guideline synchronization, materials exigencies, task-shifting, and provider resilience.

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.

Background Pulmonary arterial hypertension (PAH) carries a poor prognosis if not promptly diagnosed and appropriately treated. The development and approval of 14 medications over the last several decades have led to a rapidly evolving approach to therapy, and have necessitated periodic updating of evidence-based treatment guidelines. This guideline statement, which now includes a visual algorithm to enhance its clinical utility, represents the fourth iteration of the American College of Chest Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH. Methods The guideline panel conducted an updated systematic review to identify studies published after those included in the 2014 guideline. A systematic literature search was conducted using MEDLINE via PubMed and the Cochrane Library. The quality of the body of evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations Assessment, Development and Evaluation approach. Graded recommendations and ungraded consensus-based statements were developed and voted on using a modified Delphi technique to achieve consensus. Results Two new recommendations on combination therapy and two ungraded consensus-based statements on palliative care were developed. An evidence-based and consensus-driven treatment algorithm was created to guide the clinician through an organized approach to management, and to direct readers to the appropriate area of the document for more detailed information. Conclusions Therapeutic options for the patient with PAH continue to expand through basic discovery, translational science, and clinical trials. Optimal use of new treatment options requires prompt evaluation at an expert center, utilization of current evidence-based guidelines, and collaborative care using sound clinical judgment.

Significant variation exists in health care practice patterns that creates concerns regarding the quality of care delivered. Clinical practice based on high-quality evidence provides a rationale for clinical decision making. Resources, such as evidence-based guidelines, provide that evidence to clinicians and improve patient outcomes by decreasing unwanted variation in clinical practice. Because knowledge dissemination alone is ineffective to translate scientific evidence into clinical practice, the field of implementation science has emerged to facilitate this translation of research into routine clinical practice. This article provides an introduction to implementation science, and its application in dentistry to promote adoption of evidence-based guidelines.

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.

Early childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.Deidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.A total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).The high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Communicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.

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.

Dental service providers have limited capacity to identify strategies to implement evidence-based practices (EBPs). We developed a rigorous yet parsimonious scoping review approach to identify, select, and rate implementation strategies based on an oral health system context. From 153 strategies identified, we selected the top 11 strategies, which had a moderate level of support of evidence and where managers were the main actors. The main actions were to educate, remind, structure, and influence. Targets included dentists, dental hygienists, and assistants and managers from a large prepaid dental care delivery system. This approach responds to calls for rapid and innovative methods to implement EBPs in oral health.

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.

The advent of evidence-based practice in the 1990s led to the development of processes and resources to support the use of high-quality research in the provision of health care. As the evidence-based approach to health care continues to evolve, it has become apparent that mere creation and access to scientific knowledge is not sufficient to facilitate its routine adoption in health care. Throughout any health care system, there are inherent barriers preventing the adoption and routine use of new evidence in patient care. These barriers include provider-level factors, such as knowledge and access to new evidence, as well as each provider's attitudes and beliefs around adopting and applying the evidence with their patients. Importantly, there are also health care system-level barriers that, even among willing providers, prevent the easy adoption of new evidence and routine application in patient care. In addition to barriers, there are facilitators that help promote adoption of evidence into practice. Understanding and addressing barriers and facilitators to promote adoption of evidence into practice has led to the growth of a new field known as implementation science. Successful application of implementation science in all areas of health care, including periodontology, will help bridge the gap between what are known from clinical research to be effective treatments and what treatments should be applied routinely in clinical practice. This article reviews key concepts in implementation science and how its application in periodontology can facilitate the translation of high-quality evidence into routine periodontal practice and improved patient outcomes.

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.