Dental Need Research Articles

Impact of musculoskeletal disability limitations on the economic unmet dental needs in South Korea

BackgroundMusculoskeletal disability (MSD) has been identified as having a negative impact on oral health. Patients with MSD have a greater burden of medical expenses and are expected to have an Economic unmet dental need (UDN). This study aimed to conduct a multifactorial analysis based on the Andersen model to determine the extent to which MSD contributes to inequitable dental care use.MethodsThis study used data from the Korea National Health and Nutrition Survey VIII. The study population was 17,903 adults aged 19 years and older. All data were analyzed using IBM SPSS Statistics for Windows version 26 and the level of statistical significance was set at 0.05.ResultsThe people with MSD activity limitations were rare as only 3% in this study population. There were significant differences in sex and education as predisposing factors, income, and marital status as enabling factors, and current smoking, daily brushing, and MSD activity limitation as need factors for experiencing economic UDN. MSD activity limitation was associated with 1.5-fold increased odds of Economic UDN with a fully adjusted Anderson’s Behavior Model.ConclusionsThis finding suggests poorer access to dental care among adults with MSDs owing to financial difficulties. It is necessary to explore various ways to address oral health inequalities among adults with MSD activity limitations.

The Elderly's Limited Awareness of Advanced-Way Dental Procedures Hinders Access to Treatment, Resulting in Persistent Pain and Unmet Dental Needs in Pakistan.

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Silver Diamine Fluoride Use in Children with Special Health-care Needs: Breaking the Barriers

Dental caries is the most common unmet dental need of children with special health-care needs (SHCNs), and their treatment is challenging in routine dental settings. Based on surplus evidence, silver diamine fluoride (SDF) is a simple, safe, cost-effective, and efficient topical solution for treating dental caries. It is a clear, colorless, odorless fluoride-containing solution, does not require an extensive armamentarium for its application, and can be used in any setting. However, even with worldwide acceptance, there occurs limited research regarding SDF use in children with special needs. This review aims to update the possibilities and acceptability of SDF usage in patients with special needs with dental caries as a promising option for managing dental caries and improving their quality of life.

Barriers to dental utilization among Medicaid-enrolled young children from primary care practices in Northeast Ohio.

To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework. This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child-parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD-10 codes from the child's EHR data (individual-level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood-level using home address of each dyad (community-level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual-level alone, and individual + community-level factors to evaluate their effects on dental utilization. Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non-Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization. Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid-eligible children.

The impact of unmet treatment need on oral health related quality of life: a questionnaire survey

BackgroundBased on the present global burden of oral diseases, unmet dental needs affect a more significant population worldwide. It is characterised by the need for dental care but receiving delayed or no care. The contributing factors include lack of knowledge about oral health, its consequences, and the availability of dental services. We need to find out the scale of the problem of unmet dental needs for the south Indian population. Therefore, the objective was to determine the relationship between the presence of oral disease and the quality of life-related to oral health using the OHIP-14 tool.MethodsThe unmet dental requirements of the south Indian population were determined using a cross-sectional questionnaire survey. Close-ended questions were used to obtain data from two investigators trained to record the answers from the patients. The data was collected using the OHIP-14 questionnaire, which consists of 14 items divided into seven domains with two questions each. Physical pain, psychological impairment, physical disability, psychological disability, social disability, and disability were all considered. An additional analysis of artificial neural network (ANN) was done.ResultsThe response rate was 100 per cent. N = 1029 people replied to the questionnaire about their unmet dental needs. N = 497 (48.3%) were men, whereas N = 532 (51.7%) were women. The average age was 31.7811.72. As their current occupation, most of the included subjects (60.1%) were students. The respondents had no known personal habits and a mixed diet (94.93%). The average BMI was 24.022.59 (14-30.9). OHIP was present in 62.3% of the population. The average OHIP-14 severity score was 10.97. (8.54). The severity and degree of unmet dental need were substantial (p0.01) due to pain in the mouth/teeth/gums, malocclusion, and gum bleeding. The most common OHIP-14 domains affected by unmet oral needs were psychological discomfort, psychological limitation, social limitation, and feeling handicapped. The analysis of ANN revealed that high OHIP scores were primarily attributed to dental caries, poor oral health, and dental aesthetics.ConclusionThe severity and degree of unmet dental needs were significant among the south Indian population. The most common oral health status that impacted OHIP-14 domains were pain, malocclusion, and bleeding gums. These patients were significantly impacted by psychological discomfort and social limitations and felt handicapped.

Unmet Dental Needs in Children Following Suspension of School-Based Oral Health Services Due to COVID-19.

Dental caries (tooth decay) is the world's most prevalent noncommunicable disease and can lead to pain, infection, and edentulism. Many children with caries lack access to traditional dental services. School-based caries prevention can increase access to care and reduce health inequities. Disruptions in school-based care due to pandemic control policies may result in children losing access to their primary dental care option. The CariedAway project was a school-based caries prevention program in operation from 2019 to 2023 in urban schools with a high proportion of low-income, minority students. Program operations were suspended for 2 years due to the COVID-19 pandemic. We estimated the prevalence of untreated decay, swelling, fistula, and pulpal involvement in participants at baseline and again after restrictions were lifted. A total of 2998 children between the ages of 5 and 13 years were enrolled and received preventive care prior to pandemic shutdowns, and 1398 (47%) completed a follow-up observation after 2 years. At baseline, approximately 30% had untreated caries on any dentition, 11% of children presented with evidence of dental sealants, and no participants had swelling, fistula, or pulpal involvement. After 24 months, 12% of participants had swelling fistula, or pulpal involvement that was not treated during the pandemic period. There are considerable unmet dental needs in high-risk children that may be further exacerbated by a lack of access to care during disease outbreaks.

Impact of oral health on the quality of life of public servants: an analysis of associated factors.

Oral health encompasses functional and aesthetic aspects that directly impact an individual's daily activities. To analyze the impact of oral health conditions and related factors on the quality of life of public servants. This cross-sectional study was conducted with a sample of 89 public servants, both permanent and outsourced, from a federal public university in northeastern Brazil. Outcome was the impact of oral health on daily activities, determined by the Oral Impacts on Daily Performance indicator, and independent variables were sociodemographic characteristics, normative oral health conditions, access to and use of dental services, self-reported oral morbidity, self-perception of oral health, and absenteeism because of dental reasons. All data were analyzed using descriptive and analytical statistics, using the chi-squared test for heterogeneity and linear trend. The significance level used was set at 5%, with a 95% CI. Participants experienced at least one day of work impaired by dental problems in the six months prior to the survey. Prevalence of dental absenteeism was 7.9%. Variables associated with the impact of oral health on daily activities included gender, toothache, toothache intensity, self-reported oral health, awake bruxism, self-reported need for dentures, number of natural teeth in the upper and lower arches, and signs of temporomandibular dysfunction. Sociodemographic, clinical, and subjective oral health variables influence the impact of oral health on the daily activities of public servants.

The Geospatial Analysis of Patients Seeking Dental Care at a Private Dental Institution in Chennai, India.

Background and aim Assessing the priority of the patient towards dental needs while considering the distance traveled by them is important to improve a dental service.The purpose of this study was to rank the patients' felt needs for dental care in the private dental institution in order of importance. The objective is to count the number of patients with various major complaints and compare how far patients traveled for various treatment plans tailored to their individual needs in a private dental institution. Material and methods The sample consisted of all new patients who sought dental care at Saveetha Dental College and Hospital, Chennai, India, between January 1, 2022, and December 31, 2022. Retrospective data from the dental information archive system was gathered on their primary chief complaint and residential address.Frequency distribution of patients with different chief complaints was found. The mean and standard deviation of distance traveled by patients for different treatment plans was done using descriptive statistics using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Results The priority order of the felt need by the patients was dental pain in which n=1299 (15.4%) >missing teeth with n=1224 (14.59%) > deposit/stains/halitosis n=1149 (13.6%) > shaking tooth n=936 (11.15%) > irregularly placed/proclined teeth n=852 (10.15%) > dislodged crown/restoration n=843 (10.05%) > tooth decay/discoloration n=759 (9%) > general checkup n=723 (8.6%) > swelling/ulcer/wound n=246 (2.93%) > painful jaw/facial pain/difficult mouth opening n=198 (2.26%). In 2022, most patients requiring caries preventive measure (0.8%) located at the mean distance of 10.75±2.2 km, while patients requiring scaling (16.9%), dental filling (10.9%), endodontic management (18.6%), extraction (23.7%), prosthetic replacement (13.9%), orthodontic management (10.9%), and facial pain management (2.2%) were located at the mean distance of 14.49±8.2 km, 10.28±6.25 km, 18.43±13.9 km, 14.29±6.6 km, 23.49±11.8 km, 11.76±8.13 km, and 45.32±17.35 km, respectively. Conclusion More number of patients traveled long distances even more than 50 km for painful tooth decay. Also, lots of patients were found to seek replacement of their missing teeth next to pain. Thus, dental pain and missing teeth form a major priority of the patient's felt dental need. Also, the patient had traveled a lot for facial pain management compared to other treatment needs which shows the lack of facial pain management practice by dental care centers near their local residence.

HPR73 Underfunding of Public Health System and Unmet Dental Needs Among the European Elderly Population

HPR73 Underfunding of Public Health System and Unmet Dental Needs Among the European Elderly Population

Challenges connecting emergency department patients with oral health care: A qualitative analysis of patients, emergency department clinicians, and dentists

BackgroundUnmet dental need shares many risk factors with unmet health-related social needs (HRSN) such as housing and food security and are a common cause for seeking treatment at the emergency department (ED). MethodsThe authors recruited a purposive sample of English-speaking and Spanish-speaking patients, ED clinicians at 3 urban EDs, and dentists from nearby communities to participate in qualitative interviews to explore barriers to and facilitators of screening for HRSN and unmet dental needs in the ED. Themes were identified from transcripts using a modified grounded theory approach. ResultsInterviews were conducted with 25 ED patients, 19 ED clinicians, and 4 dentists. Four themes were identified: (1) a preference for formalized resources, which more frequently exist for HRSN than for oral health; (2) frequent use of ad hoc resources that are less reliable or structured, particularly for dental referral information; (3) limited knowledge of oral health care resources in the community; and (4) desire for more assistance with identifying and addressing resource needs for both HRSN and oral health. Patients were amenable to screening through a variety of modalities and felt it would be helpful, but clinicians emphasized the need for easier referral processes because of frequent failure to connect patients to oral health care. ConclusionsMore robust infrastructure and clinician support are needed to ensure successful referral and screening without undue provider burden for both medical and dental clinicians. Practical ImplicationsPatients are amenable to screening for unmet oral health needs and HRSN in the ED, which may improve access to care.

Dental evaluation and clearance prior to allogeneic hematopoietic cell transplantation.

Dental examination and stabilization are performed prior to allogeneic hematopoietic cell transplantation to decrease infection risk during neutropenia. Burden of dental disease and treatment need is not well characterized in this population. This report describes the dental status of a cohort of patients within the Chronic Graft-versus-Host Disease Consortium and treatment rendered prior to transplant. The cohort included 486 subjects (Fred Hutchinson: n = 245; Dana-Farber: n = 241). Both centers have institutional-based dental clearance programs. Data were retrospectively abstracted from medical records by calibrated oral health specialists. The median age at transplant was 55.9 years, 62.1% were male, and 88% were white. Thirteen patients were edentulous (2.7%). The mean teeth among dentate patients before clearance was 26.0 (SD, 4.6). Dental findings included untreated caries (31.2%), restorations (91.6%), endodontically treated teeth (48.1%), and dental implants (5.7%). Pretransplant procedures during clearance included endodontic therapy (3.6%; mean = 0.1 teeth), restorations (25.1%; mean = 0.7), dental prophylaxis (59.2%), scaling/root planing (5.1%), and extraction (13.2%; mean = 0.3). The mean teeth after clearance was 25.6 (SD, 5.0). Retrospective analysis of pre-AlloHCT dental data in subjects at two large transplant centers identified low levels of dental need. Findings suggest high access to care.

Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health.

Dentists often use sedative medications such as nitrous oxide inhaled sedation and general anesthesia (GA) to help decrease patient fear and manage paediatric patients' behavior during treatment. The goal of this study was to examine factors associated with dental fear changes after restorative dental treatment under nitrous oxide or GA in children 4-12 years old. A prospective cohort study of 124 children examined changes in dental fear, number of treatment visits, and parental factors among children receiving restorative dental treatment under nitrous oxide (n = 68) or GA (n = 56) sedation. Data were collected at pretreatment (T1), 16 weeks post-treatment (T2), and at 29-month follow-up (T3). Dental fear increased slightly, but not significantly, under both forms of sedation between T1 and T3. Children's dental fear was associated with parents' poor dental experiences and oral health, but not with number of treatment visits. Progression of children's dental fear seems not dependent solely on the type of sedation used but is likely predicted by factors including pretreatment dental fear and dental needs. Dentists recommending sedation for children's dental care may consider pretreatment dental need, fear levels, and parental factors when determining which type of sedation to use.

Acculturation and Children's dental service utilization in the United States.

The study examined changes in acculturation level, socio-economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs. Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross-sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio-economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator. Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio-economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization. Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio-economic status.

Edentulismo e fragilidade em pessoas idosas domiciliadas: um estudo transversal

Abstract Objective To investigate the association between frailty and edentulism in community-dwelling older adults and determine the individual, sociodemographic, and clinical factors associated. Method A total of 333 older adults aged 65 years or more participated in this study; they responded to the Edmonton Frail Scale instrument (EFS). Data on socioeconomic factors, oral health, and use of and need for dentures were also collected. Those with cognitive difficulties were excluded. Hierarchical multivariable logistic regression models were performed using the stepwise and backward procedure, which tested the relationship of edentulism and covariates with EFS results. Variables with p<0,20 in the unadjusted analyzes were included in the adjusted logistic regression. Results The prevalence of moderate to severe frailty was 12.3%. Edentulism was related to frailty (OR 3,45; IC 95%: 1,45 – 8,25; p=0,01), age (OR 2,19; IC 95%: 1,07 – 4.46; p=0,03), female sex (OR 2,75; IC 95%: 1,23 – 6,15; p=0,01), the need of lower dental prosthesis (OR 3,19; IC 95%: 1,27 – 8,05; p=0,01) and toothache perception (OR 2,74; IC 95%: 1,15 – 6,15; p=0,02). Conclusions Frailty was associated with edentulism, age, female sex, the need for lower dental prosthesis and toothache perception. These oral conditions are highly prevalent among older adults and can be prevented by multiprofessional actions supported by public policies. Oral examinations should be considered in pre-frail and frail patients’ assessments as oral health indicators were associated of older adults’ frailty.

Edentulism, need for dentures, and self-perception of oral health among institutionalized older people

RESUMO Objetivou-se descrever a condição de saúde bucal de idosos institucionalizados, com enfoque no edentulismo, na necessidade de prótese e na Autopercepção de Saúde Bucal (ASB), e explorar a associação com fatores individuais. Um estudo transversal foi realizado em Ponta Grossa, município do Sul do Brasil, com amostra de conveniência de idosos residentes em três Instituições de Longa Permanência para Idosos. Por meio de questionário estruturado, foram coletados dados sobre características demográficas, de saúde geral e bucal e acesso a serviços de saúde. No exame bucal, avaliou-se o Índice de dentes permanentes Cariados, Perdidos e Obturados (CPO-D), número de dentes presentes, uso e necessidade de prótese dentária e presença de lesões bucais. Foram avaliados 130 idosos, a maioria com mais de 80 anos (62,20%). O CPO-D médio foi de 30,62 (desvio-padrão 2,85), 62,31% dos idosos eram edêntulos, 41,54% usavam e 79,23% necessitavam de prótese dentária. As lesões bucais foram identificadas em 35,42% dos avaliados, e 64,86% dos idosos classificaram a ASB como boa. Conclui-se que a saúde bucal dos participantes foi considerada ruim, do ponto de vista clínico, levando em consideração a alta prevalência de edentulismo e a necessidade do uso de prótese dentária.

Oral Health Status of Outpatients with Schizophrenia in Ankara, Türkiye: A Descriptive Study.

To evaluate the oral health status and denture treatment needs of a group of outpatients with schizophrenia. One hundred and eighty-eight patients diagnosed with schizophrenia were evaluated. Socio-demographic characteristics, eating habits, alcohol consumption, smoking status, oral hygiene attitudes, medical status, medications and the data related to dental visit were obtained via structured questionnaire of 45 questions. Medication information were confirmed from hospital records. The DMFT score (the Total of decayed, missing and filled teeth), denture status, Community Periodontal Index of Treatment (CPITN) and attachment loss were recorded in accordance with the criteria defined by the WHO. The mean DMFT score was 11.1±8.6. Total number of teeth decreased, while the number of decayed teeth and DMFT scores increased with age (p<0.001). There was no relationship between the anticholinergic effects of antipsychotics and the teeth count, number of decayed, filled and missing teeth, and the DMFT scores. The CPITN assessment revealed that 71.6% of the patients had healthy periodontium, 7.4% exhibited gingival bleeding upon probing, and 21% had dental calculus. Psychotropic medication and tooth brushing habits were associated with CPITN scores. Male sex was associated with higher frequency of denture need (p<0.001), while no association was observed with the education level and antipsychotic use (p>0.001). Physicians and dentists have to work in coordination to maintain good oral health of patients with schizophrenia. Patients should be encouraged for regular dental check-ups and dentist should take utmost care of the oral hygiene maintenance.

Changes in dental and medical visits before and during the COVID-19 pandemic among U.S. children aged 1-17 years.

The COVID-19 pandemic has tremendously impacted the U.S. healthcare system, but no study has examined the impact of the pandemic on utilization of dental care among U.S. children. Changes in past-year dental versus medical visits and perceived unmet health needs between 2019 and 2020 among U.S. children aged 1-17 years were examined. National and state representative, cross-sectional data from the National Survey of Children's Health conducted during June 2019-January 2020 (i.e. pre-pandemic, n=28 500) and July 2020-January 2021 (i.e. intra-pandemic, n=41 380) were analysed. Any past-year visit and perceived unmet needs (i.e. delay or inability to receive needed care) were reported by the parent proxy. Weighted prevalence estimates were compared using two-tailed chi-squared tests at p < .05. Poisson regression analyses were used to explore the relationship between having dental and/or medical unmet needs during the pandemic and indicators of poor health and social wellbeing. Between 2019 and 2020, a significantly reduced prevalence of past-year medical (87.2%-81.3%) and dental visits (82.6%-78.2%) among U.S. children aged 1-17 years (all p < .05) were observed. Correspondingly, perceived unmet needs increased by half for dental care (from 2.9% in 2019 to 4.4% in 2020) and almost one-third for medical care (from 3.2% to 4.2% in 2020). Subgroups with the highest prevalence of unmet dental need included those with low socio-economic status, living with their grandparents, uninsured and living with a smoker. Unmet health needs increased in general but increased more for dental than for medical care among U.S. children aged 1-17 years. Enhanced and sustained efforts will be needed to deliver targeted services towards disadvantaged segments of the population to narrow existing disparities.

Relationship between Precarious Employment and Unmet Dental Care Needs among Korean Workers: A Longitudinal Panel Study.

Background and Objectives: Precarious workers experience certain conditions, such as low income, instability in employment, and lack of social security. Precarious employment has increased barriers to the use of dental care services, resulting in more unmet dental care needs. The aim of this study was to identify unmet dental care needs among precarious workers in Korea's labor market, using data from the Korea Health Panel Survey (2011-2017). Materials and Methods: Based on job and income security criteria, four groups were formed: Group A (individuals with job and income security), Group B (individuals reporting job security with income insecurity), Group C (individuals reporting job insecurity with income security), and Group D (individuals with job and income insecurity). We measured self-reported unmet dental need or the inability to receive necessary dental care owing to the past economic burdens. Panel logistic regression analyses were performed to determine the effect of precarious employment on unmet dental care needs for all participants. Results: Approximately 16% of the respondents reported having unmet dental care needs. Unmet dental care needs owing to economic reasons were higher among male workers in groups C and D than among male workers in Group A. In particular, male workers aged 50 years and above in Group B were 3.36 times more likely to have unmet dental care needs than those in Group A. In Group D, female workers showed a high probability of having dental care needs owing to economic reasons. Moreover, female workers aged 18-49 years witnessed an increase in unmet dental care needs. Conclusions: Korean workers with unstable employment and/or income are at a higher risk of having unmet dental care needs owing to financial factors. The findings suggest an urgent need to implement robust national health insurance policies to improve efforts aimed at reducing unmet dental care needs that potentially decreases the disparity in oral health among precariously employed workers. Furthermore, it is necessary to implement comprehensive labor market policies such as sickness benefits for those in precarious employment.

Assessment of Parental Perceptions of Socio-Psychological Factors, Unmet Dental Needs, and Barriers to Utilise Oral Health Care in Autistic Children.

Introduction: Parents' participation is crucial in the dental health intervention of children with autism spectrum disorder (ASD). Parenting children with ASD is extremely stressful and challenging. Parents and other caregivers have a responsibility to care for and raise children with ASD. Parental perception of the condition, situational adaptation, and attitude towards the issue are significant indicators of how they will respond and eventually adapt to it.Methodology: A comparative, descriptive study was done on parents of 154 autistic children and 235 normal children. An 11-variable questionnaire eliciting various details of socio-psychological factors affecting the utilisation of oral health care was designed and validated. The questionnaire also included parameters regarding barriers to accessing dental services. The dental caries and oral hygiene status of all children were examined using the Basic Oral Health Survey 2013 proforma. Chi-square and independent t-tests were applied to find significant differences between the groups.Results: A greater number of male children (61.0%) were observed among autistic children. Parental perception regarding socio-psychological concerns with raising an autistic child showed significant differences for all variables between the groups except for assistance in the child’s task with 90.2% as against 55% of the parents with non-autistic children. Parents of autistic children were more receptive to the idea of focus group discussion. Decayed teeth were significantly found to be higher in autistic cohorts (2.554 ± 1.616 versus 1.779 ± 1.841). Oral hygiene status was also statistically significant amongst autism-affected children than those who were not at p =0.000.Conclusion: The present study explored various socio-psychological factors of parental perception of autistic children. A better outcome can be suggested when parents gained awareness regarding various strategies and treatment options available for their child's oral health. Furthermore, dental health can be improved by bringing in certain environmental modifications in which the autistic child is groomed.

Medical-Dental Integration: A Promising Approach To Address Unmet Dental Needs of Children and Youth With Special Health Care Needs

Background: This review presents strategies on how medical-dental integration and a patient-centered approach may address the unmet dental needs of children and youth with special health care needs (CYSHCN).Methods: Programs, strategies and frameworks to implement medical-dental integration to improve the overall quality of life of CYSHCN were reviewed. The authors propose a patient-centered health home (PCHH) as a step toward a patient-centered approach to medical-dental integration for CYSHCN.Results: Many federal, state and local organizations have emphasized the importance of medical-dental integration. Models and frameworks to implement integrated care in multiple settings have been developed and can be applied for CYSHCN. The proposed PCHH model includes integrated education, improved clinical collaboration, integrated health information technology and integrated financing. Ravenswood clinic is an example of an organization that has developed an integrated care model that serves children and adults with special health care needs.Conclusion: CYSHCN often seek services from multiple specialties that may or may not integrate care with a patient-centered approach. It is imperative to develop care systems that make oral health an inseparable part of general health and well-being.Practical implications: The PCHH is a promising approach to improve the overall health of CYSHCN. Incorporating oral health competencies for primary care providers and increasing the skills of dental providers to care for CYSHCN are important steps. Improved communication and clinical collaboration between dental and primary care providers to increase preventive dental services to CYSHCN will reduce the burden on the health care system. However, PCHH can only be practical by reforming the health care financing system.