Dental Care Delivery System Research Articles

Basic research for the development of quality measures of oral care in Korea

The aims of this study were to evaluate quality indicators that can be applied to the dental care delivery system in Korea. This study was performed with a three-step process. Firstly, authors searched for quality indica-tors developed in dentistry field. Among them, 80 quality indicators were selected as the indicators that used indental institutions, and then 33-item preliminary list was extracted through evaluation by 9 experts consisted of dental clinicians and professors (college of dentistry and department of dental hygiene). Based on this 33-item preliminary list, a Delphi process was conducted twice by a stakeholder group consisting of 17 panels (dentists, dental hygienists, dental technicians, professors of dental colleges, and dental hygiene professors). Each item of the preliminary list was classified into 5 domains of importance, relevance, feasibility, reliability, and sensitiv-ity. The panels were asked to rate from 0 to 3-point (very unnecessary - very appropriate) to the 5 domains of all items. As a result, the sealant treatment item received the most consent, and the item of whether unnecessary antibiotics is prescribed received the lowest preference. Among the 33 items, the items that received a score of 2.5 or higher were sealant, brushing, fluoride application, caries prevention, periodontal management, regularcheck-up, continuity of treatment, and evaluation of current symptoms. This study was performed as basic re-search. Based on international consensus on the definition of the quality of oral health care, development of newmeasures is necessary to produce quality indicators that suitable for the dental setting in Korea.

Policy Study for Improvement of the Dental Care Delivery System in General Hospital

The purpose of this study is to investigate the opinion of dental specialists on the reasons for the decrease in the role of dentistry in general hospitals and to propose improvement plans of the dental care delivery system. A survey was conducted using Google Survey, and 113 respondents out of 713 dental trained capable specialists were the final objects of this study. The variables were age, position, major, and opinion on the role and measures for the improvement of dentistry in general hospitals. As results, the role of dentistry in general hospitals included providing not only complex dental services, training and education, but R&D functions. For improving the role of dentistry, government and legal supports are required, which include amendments of training hospital standards and recruitment of dentists in medical emergency institutions. Finally, this study suggests mitigations of designation criteria for dental training centers in general hospitals with more than 300 beds. The current internship system need to be abolished, and legislation for emergency dental treatments through the Emergency Medical Act is required.

TELEDENTISTRY DURING COVID 19

The ongoing COVID19 pandemic has been a jarring blow to dental professionals as dental treatment requires close face-to-face encounters. To sustain the dental practice, Teledentistry is a cogent solution to continue providing dental care without adding to the risk of cross-infection via information technology. It is a necessary tool to obtain a balance between the safety of health care professionals still providing dental care to patients needing immediate intervention. The future of teledentistry is not limited to the pandemic its improvident to restrict the use of teledentistry when it has the potential to enhance the present dental health care delivery system.

Applying a scoping review approach for identifying effective implementation strategies in oral health settings.

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.

Provider and community perspectives of dental therapists in Alaska's Yukon-Kuskokwim Delta: A qualitative programme evaluation.

Dental therapists deliver preventive and basic restorative care and have been practicing since 2006 in Alaska's Yukon-Kuskokwim (YK) Delta. In this qualitative programme evaluation, we documented health providers' and community members' experiences with dental therapy. The goal of the evaluation was to develop a conceptual model of dental care delivery in Alaska Native Communities centred on dental therapists. We developed semi-structured interview scripts and used snowball sampling to recruit 16 health providers with experience providing care in the YK Delta and 125 community members from six YK Delta Communities in 2017 and 2018. The six communities were a stratified convenience sample based on community-level exposure to dental therapists (high, medium and no exposure). Interview data were digitally recorded, transcribed, verified for accuracy and coded inductively into conceptual domains using content analytic methods. Providers believed individuals living in the YK Delta have benefited from clinic-based restorative care and community-based education provided by dental therapists. The restricted scope of dental therapy practice limits the complexity of care that may be offered to patients. However, community members expressed high satisfaction with the quality of care provided by dental therapists. Community members noted more widespread knowledge and evolving norms about oral health and believed dental therapists are helping to prevent disease and improve quality of life. Participants believed access to dental care for children has improved over the years, but felt that many adults in the YK Delta continue to have unmet needs. A potential barrier to sustained programme effectiveness is low retention of dental therapists in the region, driven primarily by reports that dental therapists feel overworked, stressed and geographically isolated. Dental therapists have contributed to the dental care delivery system in Alaska's YK Delta. Future opportunities remain within the system to address the needs of adults, develop strategies to retain dental therapists in the region and incorporate evidence-based, prevention-oriented strategies to improve oral health behaviours and reduce oral diseases.

Advancing Dental Education in the 21st Century: Developing the Phase 2 Strategic Analysis and Recommendations.

The dental care delivery system is undergoing a fundamental transition, and it is driving changes in dental education. The traditional practice model for the past 180 years, based on owner-operated solo dental practices, is now moving to large group practices owned by corporations, health

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Policy entrepreneurship in the reform of pediatric dentistry

In a recently published IJHPR article, Cohen and Horev ask whether an individual who holds rightful governmental power is able to effectively “challenge the equilibrium” in ways that might “clash with the goals” of an influential group”. This question is raised within the context of a shift in governmental policy that imposed the potential for cost management by HMOs acting as financial intermediaries for pediatric dental care in an effort to provide Israeli children better access to affordable dental care. The influential group referred to consists of Israel’s private dentists and the individual seeking to challenge the equilibrium was an Israeli Minister of Health whom the authors consider to be a policy entrepreneur.The Israeli health care system is similar to that of the United States in that private benefit plans and self-pay financing dominate in dental care. This is in contrast to the substantial role of government in the financing and regulation of medical care in both countries (with Israel having universal coverage financed by government and the US having government financing the care of the elderly and the poor as well as providing subsidies through the tax system for the care of most other Americans).Efforts to expand governmental involvement in dental care in both countries have either been opposed by organized dentistry or have suffered from ineffective advocacy for increased public investment in dental care.In the U.S., philanthropic foundations have acted as or have supported health policy entrepreneurs. The recent movement to introduce the dental therapist, a type of allied dental professional trained to provide a narrow set of commonly-needed procedures, to the U.S. is discussed as an example of a successful challenge to the equilibrium by groups supported by these foundations. This is a somewhat different, and complementary, model of policy entrepreneurship from the individual policy entrepreneur highlighted in the Cohen-Horev paper.The political traction gained to change the equilibrium favored by organized dentistry – in both Israel and the U.S. - may reflect aspirations for care that is more accessible, patient-centered, accountable and equitable. Evolving aspirations may lead to policy changes to systematize the disparate, disaggregated dental care delivery system in both counties. A change in payment incentives to provide more value is being explored for medical care, and its expansion to dental care can be anticipated to be among the policies considered in the future.

Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed.

Dental coverage for adult enrollees is an optional benefit under Medicaid. Thirty-one states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act. Millions of low-income adults have gained health care coverage and, in states offering dental benefits, oral health coverage as well. Using data for 2010 and 2014 from the Behavioral Risk Factor Surveillance System, we examined the impact of Medicaid adult dental coverage and eligibility expansions on low-income adults' use of dental care. We found that low-income adults in states that provided dental benefits beyond emergency-only coverage were more likely to have had a dental visit in the past year, compared to low-income adults in states without such benefits. Among states that provided dental benefits and expanded their Medicaid program, regression-based estimates suggest that childless adults had a significant increase (1.8 percentage points) in the likelihood of having had a dental visit, while parents had a significant decline (8.1 percentage points). One possible explanation for the disparity is that after expansion, newly enrolled childless adults might have exhausted the limited dental provider capacity that was available to parents before expansion. Additional policy-level efforts may be needed to expand the dental care delivery system's capacity.

After Medicaid Expansion In Kentucky, Use Of Hospital Emergency Departments For Dental Conditions Increased.

Access to oral health care is a critical need for the adult Medicaid population. Following the 2014 expansion of Medicaid eligibility in Kentucky, millions of adults became eligible to receive dental benefits. We examined the impact of the expansion on adult Medicaid enrollees' use of hospital emergency departments (EDs) for conditions related to dental or oral health in the period 2010-14. Based on our analysis of data for Kentucky from the State Emergency Department Databases, we found that the rate of discharges for these conditions from the ED increased significantly, from 1,833 per 100,000 population in 2013 to 5,635 in 2014. Adults covered by Medicaid who used the ED for treatment of oral health conditions in 2014 had high levels of chronic comorbidities and were more likely to be male and nonwhite than those in earlier years. To avoid costly and inappropriate use of the ED, states considering adding an adult Medicaid dental benefit should consider also making changes to assist beneficiaries in obtaining access to the dental health care delivery system.

Improving the Oral Health of American Indians and Alaska Natives

American Indian and Alaska Native people experience more oral disease and are more likely to have unmet oral health needs than the general US population. These disparities may be attributed to limited access to and use of the dental care delivery system plus a high prevalence of disease risk factors such as social inequities, diet and infant-feeding practices, smoking, and oral hygiene behaviors. This review provides information on the use of and effectiveness of strategies designed to increase access, prevent oral disease, and change systems. To address the oral health crisis in Indian Country, a multi-modal approach which engages the individual, family, community, tribal leadership, plus health and social service providers must be developed, implemented, and sustained. This multi-modal approach should combine primary, secondary, and tertiary prevention strategies layered with strategies to increase access and system changes to reduce the consequences of social inequities.

Gaps in need, demand, and effective demand for dental care utilization among residents of Krishna district, Andhra Pradesh, India.

Aims:To identify the relation between need, demand, and effective demand for dental services in Andhra Pradesh, India.Materials and Methods:This is a cross-sectional study performed among populations residing in the rural and urban areas of Krishna district, Andhra Pradesh, India. Data were collected from 3102 individuals who were selected through multiphase random sampling. Data regarding self-perceived dental need, dental service utilization, and barriers for utilization were collected through s pretested questionnaire followed by type-III clinical examination to assess the normative need of the individuals. Chi-square test was used to compare independent and dependent variables, and further comparison was done with multivariate logistic regression analysis for significant variables.Results:Less than half (40%) of the participants perceived a need for dental care. Among the people who perceived need for care, only 21.4% utilized dental care and 78.6% of them had unmet dental needs. The two main reasons for not seeking dental care was lack of money, i.e., unaffordable dental treatment (48%) and having the perception that they do not have any dental problem (19.4%).Conclusions:There is an enormous difference between normative need, demand, and actual utilization rates in dental care, and hindrances for effective demand need to be addressed to improve dental care delivery system.

ERGONOMICS-THE LAW OF WORKING

Ergonomics, the science that studies human stress a nd strain related to activities, has one primary ob jective-to prevent work related musculoskeletal disorders, or symptoms that aggravate these disorders. Repeated unnatural, deviated or inadequate working postures, forceful h and movements, inadequate equipment or workplace designs and inappropriate work patterns are likely to be the pa rticular risk factors. The application of ergonomic s to dentistry, or dento-ergonomics, can increase efficiency and preve nt injury. Among the factors that need to be consid ered are the height and reach of staff members, the equipment be ing used and the distribution of tasks. By implemen ting the theories of ergonomics, dental care providers can p rolong their interest and commitment to dentistry b y making difficult or even painful tasks less stressful. Th e paper shows that ergonomics can have a large impact on the effectiveness of dental health care delivery system s. So we suggest the idea that the study of ergonom ics should be included in the dental curriculum.

Assessing the contribution of the dental care delivery system to oral health care disparities.

Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentists. This approach overlooks the importance of other aspects of the dental care delivery system, such as personal and practice characteristics of dentists, that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. We merged data from the 2003 California Health Interview Survey and a 2003 survey of California dentists in their Medical Study Service Areas (MSSAs). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. We found that some characteristics of MSSAs, including higher proportions of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees, inhibited access for low-income and minority populations. These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed-dentist-to-population ratios. The findings identify specific aspects of the delivery system such as dentists' participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender that should be regularly monitored. These data will provide a better understanding of how the dental care delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities.

Teledentistry: A New View on Oral Health Care

Technologic innovations in the field of dentistry have been extensive in recent years. Just as communication technology and uses of electronic information has developed over the years, terms to describe the health care services at a distance, such as telehealth and telemedicine, have also evolved. Teledentistry is a synergistic combination of telecommunication and dentistry. It is a relatively new field that can change the dynamics of the dental care delivery system. It has implications not only in urban set up but also meets the dental care needs of the underserved in the rural areas of India. It involves the local dentist digitizing and electronically transmitting drawings, diagrams, photographs, and x-rays to a specialist. Teledentistry approaches may hold the potential to address many of the problems related to access, cost efficiency, and quality of dental care. It also has the ability to improve the access and delivery of the oral health care. Most of the dentists are unaware about the goals and advantages of teledentistry. This article reviews the origin, rationale, basis, requirements and scope of teledentistry.

The oral health of seniors in Brazil: addressing the consequences of a historic lack of public health dentistry in an unequal society

National epidemiological data on the oral health of elders was analysed to examine relationships between the need for oral treatment and external environment, the dental care delivery system, personal characteristics and subjective conditions of oral health. Brazil's universal public healthcare system is theoretically responsible to provide dental care to Brazilians of all ages. However, as dentists were integrated into public primary care facilities only in 2000, Brazilian seniors have accumulated needs. Seniors (65-74 years old) were examined and interviewed by calibrated professionals. The association of overall need for oral treatment and component factors were analysed. Associations with socio-demographic factors and self-reported attitudes and behaviours were also calculated. A total of 85.9% of Brazilian seniors demonstrated a need for some oral treatment, 83.8% of the dentate needed periodontal treatment and 57.3% of all seniors needed full or partial prostheses. Social inequalities were also evident as Brazilians using free oral care services demonstrated a higher degree of need, as did elders who had not previously accessed dental services, nonwhites and males. Our findings demonstrate that the elderly population in Brazil has a very high degree of need in general and that certain subgroups have been especially vulnerable to oral disease.

Dental Public Health! A Mistaken Identity

The dental public health field has been expanding in scope & complexity with more emphasis beingplaced on the total dental care delivery system and its impact on oral health status.A broadly accepted definition of "dental public health" has been given byDowner 1994: "The science and art of preventing oral disease, promotingoral health and improving quality of life through the organized effortsof society" (Downer et al,1994). A broader definition was made ten years later as follows: "The scienceand art of preventing oral disease, promoting oral healthand improving quality of life through the organized efforts and informedchoices of society, organizations, public and private, communities andindividuals" (Pine & Harris 2007).The purpose of an oral health care system is to influence the population’s way of life so that oral healthis promoted or maintained and oral disease prevented; and to promote adequate treatment to thosemembers of the population affected by oral disease so that disease is arrested at an early stage andloss of function is prevented. These functions apply whether the service is in a developing or developedcountry.

Medicaid Reforms in Oregon and Suboptimal Utilization of Dental Care by Women of Childbearing Age

The authors conducted a study of dental services used by women of childbearing age who were enrolled in Medicaid in Oregon during the early 2000s, a period of reform during which health care coverage was expanded. They compared claims for pregnant women, women who were not pregnant and had children and women who were not pregnant and did not have children. They also compared differences in claims between those for women enrolled in managed care and those for women enrolled in fee-for-service plans. The authors computed the proportion of women for whom a dental claim was submitted in six-month spans for 2000, 2001, 2002 (before reform) and 2005 (after reform). Before and after reforms, the mean utilization rate for pregnant women, adjusted for the proportion of the period covered, decreased from 0.36 (standard deviation [SD] = 0.025) to 0.22 (SD = 0.028). Among women who were not pregnant and had children, the average adjusted rates decreased from 0.49 (SD = 0.201) to 0.21 (SD = 0.078). The pattern was similar among women who had no dependent children: rates decreased from 0.50 (SD = 0.028) to 0.19 (SD = 0.078). Most of the claims were for diagnostic services. The authors found no differences between women enrolled in managed care and those enrolled in fee-for-service plans. Contrary to their intention, health care reforms in Oregon were detrimental to the vulnerable populations that Medicaid is intended to serve. Dental care is important for maternal and child health. However, utilization is unlikely to improve without changes in Medicaid and the dental care delivery system.

Understanding and enhancing the dental delivery system

Dental decay is the most prevalent chronic disease among both children and adults in the U.S. The Surgeon General's Report on Oral Health found that there had been marked improvement in oral health in many Americans over the last 50 years and that good oral health could be achieved by all Americans largely due to the presence of safe and effective interventions to prevent and control oral disease However, recent national data suggest that several disparities in dental care exist. In this chapter, we present a model of the dental health system as well as key differences with the general medical health system. We further discuss the major issues that the dental care delivery system will have to address in order to ensure that all Americans have access to effective interventions to prevent and control disease in an environment of decreasing supply of dentists per capita and potentially increasing demand. We then discuss strategies and policies to address these emerging issues in the context of this model. Finally, we conclude with suggestions on how engineering techniques could be used to improve the system.

Use of Dental Service Data to Inform Research and Policy

Data collected routinely in dental care delivery systems could be used to inform research and policy. Projects in which data were collected with the help of general dental practitioners are outlined. In an EU-funded project, six partners collaborated to develop a methodology designed to establish links between characteristics of a health care system and health outcome, and to determine the characteristics of oral health care systems which promote oral health and those which are detrimental to oral health. The results indicated that the data collected in the different systems investigated varied enormously, and they could not be easily adapted to help in developing policy. A theoretical model was developed in which the production of oral health care was considered separately from the production of oral health. In the second example, the longevity of the restorations in a dental care delivery system in Ireland was investigated by routine service data.