Oral Health Risk Assessment Research Articles

Development and validation of betel-year: a clinical tool for quantifying exposure to betel quid chewing, utilizing nuclear morphometric analysis and validated by cytomorphological analysis

BackgroundBetel quid chewing, prevalent in Southeast Asia and South Asia, involves components such as betel leaf, areca nut, slaked lime, and sometimes tobacco. This study aims to assess buccal mucosa changes in betel quid chewers, develop a clinical tool for assessing exposure, and investigate its usability in predicting dysplasia.MethodsAfter obtaining ethical approval and informed consent, patients were recruited from the Out-Patient Department of Government Medical College, Omandurar, Government Estate, India. A target sample size of 200 was calculated. The data included the history of betel quid chewing, buccal mucosa cells obtained by oral cytology, and the severity of dysplasia of the slides assessed by pathologists. We utilized principal component analysis (PCA) and confirmatory factor analysis (CFA) to validate a new outcome variable reflecting nuclear morphometric parameters (NMPs). Multiplicative regression models were developed for betel years based on betel exposure and additives. Spearman correlation and Kruskal-Wallis test was used to check the association between betel years and dysplasia.ResultsSignificant differences in NMPs were observed among different betel chewing groups. We derived multiplicative regression models for betel years. In the logarithmic transformation approach, betel year = 0.05×betel-exposure×0.09×slaked-lime use×0.11×tobacco-use. In the original variable approach, betel year = 5.05×betel-exposure^0.00048×slaked-lime-use^0.18133×tobacco-use^1.47513. Spearman correlation and Kruskal–Wallis tests confirmed associations with dysplasia.ConclusionBetel year is a pioneering tool for assessing lifetime betel quid exposure, similar to pack years for smoking. It could aid in risk stratification, targeted interventions and shaping public health policies. Despite limitations, betel year holds promise for revolutionizing oral health risk assessment, and future research can expand its scope globally, considering diverse betel quid compositions.

Knowledge and Attitude of Obstetricians about the Effects of Oral Health, Dental Care and Management among Pregnant Ladies in Omdurman Maternity Hospital and Gynecological Omdurman Military Hospitals, Sudan in 2020

Background: Every expectant mother should receive a comprehensive oral health education and risk assessment. Numerous reports have shown an association between oral diseases and preterm, low birth weight. The aim of this study was to assess the knowledge and attitude of obstetricians about the effects of oral health, dental care and management among pregnant ladies in Omdurman Maternity Hospital and Gynecological Omdurman Military Hospitals, Sudan in 2020. Methods: This cross sectional study involved a survey of 100 obstetricians (male and female) from Omdurman maternity hospital and military hospital, the data derived from this research has been collected by self- administered questionnaire. Data has been analyzed using SPSS version 23. Result: This study included 100 participants 52% female and 48% male. The age of the participants started from 25 years old with the most of the respondents aged between (25 and 35 years old) and the result showed that 92% of obstetricians referred their patients to dentists, 84% believed that gingival disease affects birth weight, 40% agreed that abortion is the effect of oral disease in pregnancy. Conclusions: In this study regarding the knowledge and attitude of obstetricians about dental care during pregnancy we found that 92% of obstetricians referred their patients to dentists, 40% agreed that abortion is the effect of oral disease in pregnancy and 36% believed that gingival bleeding is the effect of pregnancy on oral health.

Poor Oral Health in Trauma Intensive Care Unit Patients: Application of a Novel Oral Health Score.

Background: Although oral hygiene in patients in the intensive care unit (ICU) has been shown to reduce hospital-associated infections, baseline and progressive oral health are often not reported because of lack of a standardized tool. The Oral Health Risk Assessment Value Index (OHRAVI) is a comprehensive oral assessment validated by dental providers. This study hypothesizes that non-dental providers can use OHRAVI in trauma ICU patients with minimal training and acceptable inter-rater reliability (IRR). Patients and Methods: Dentulous adult patients in the ICU at a level 1 trauma center were scored, excluding those with severe orofacial trauma. The eight categories of the OHRAVI were scored 0 to 3 (best to worst) with summed total and index (average) score. Index scores 1 or less need routine oral care; greater than 1-2 require moderate care; and greater than 2-3 require extensive oromaxillofacial care. Inter-rater reliability was assessed by two to three raters with Krippendorff's α (≥0.80 for good and ≥0.667 for acceptable). Results: Eighty-four ratings were completed across 34 patients, with 16 patients (47%) scored by all three raters. Ten patients (29%) had an index score <1. The average index score for patients was 1.28 (median, 1.34; range, 0.63-2). Krippendorff's α for index score was 0.86. For individual categories, α ranged from 0.44 to 1, with six of the eight categories achieving an α ≥ 0.667. Conclusions: With minimal training, non-dental providers were able to use OHRAVI with a good IRR for index score and an acceptable/good IRR for most individual categories. This novel, simple, comprehensive oral health score could help standardize oral assessment and facilitate future studies of peri-operative oral hygiene interventions.

An interprofessional school-based initiative to increase access to oral health care in underserved Florida counties.

To examine and describe the effect of an oral health education program on school-based nurses' acquisition of oral health knowledge. Three-hour synchronous videoconference sessions provided training for nurses to conduct oral health risk assessments, screen for oral diseases, deliver oral health education, apply fluoride varnish, and refer children identified in need of further assessment and treatment to a dentist. Oral health knowledge acquisition was assessed by comparing pre-training and post-training examination scores. Analyses included descriptive statistics and the Wilcoxon signed-rank test. Seventeen nurses from Suwannee, Lafayette, and Hamilton counties participated in the oral health education training program. Analyses of the school-based nurses' test results showed a significant increase in correct answers on the post-training test (93%) compared to the pre-training test (56%). Six hundred forty-one children from six elementary public schools received oral health education, oral screenings, and fluoride varnish applications. Fifty-eight percent of the children had untreated caries, 43% had treated caries, 15% had sealant on permanent molars, and 3% required urgent care. Nurses successfully referred children identified in need of further assessment and treatment to a dentist. The synchronous videoconference oral health training program was effective in improving school-based nurses' oral health knowledge. The knowledge acquired by school-based nurses via oral health training programs can be leveraged to increase access to oral health care for vulnerable and unserved school-aged populations.

Relationship between an Oral Health Risk Assessment Using a Salivary Multi-Test System and Woman's Subjective Oral Health Symptoms and Sleep Disorder.

Saliva is used as a diagnosis and monitoring tool for various diseases because it can maintain the balance of the oral ecosystem and reflect the physiological and pathological state of the body. Because women suffer more fatigue than men because of physiological, psychological, and social factors, individual management strategies are needed to evaluate mental health and oral diseases. Therefore, this study examined the oral health risk level from seven saliva factors using a saliva multi-test system for adult women to confirm the possibility of screening for sleep disorders. The saliva of 83 adult female participants was surveyed along with a self-reported questionnaire consisting of seven subjective oral health symptoms and three questions about sleep disorders. Seven saliva factors were evaluated using the saliva multi-test system (SiLL-Ha ST-4910) to assess the oral health risk levels. In the tooth health risk groups, the acidity was high, while the buffering capacity was low (p < 0.001). The periodontal health risk groups showed significant differences in acidity, occult blood, leukocytes, proteins, and ammonia (p < 0.05). The oral malodor risk group had higher levels of cariogenic bacteria, occult blood, leukocytes, and ammonia (p < 0.05). In groups with 'irregular sleep times' and 'insomnia', the acidity was high, and the buffering capacity was low (p < 0.001). This study confirmed the relevance of saliva factors and sleep disorder. Therefore, an evaluation using saliva was confirmed for oral health risk assessments and as an early screening tool for sleep disorders.

MORE Care: an evaluation of an interprofessional oral health quality improvement initiative.

This evaluation assesses the Medical Oral Expanded Care (MORE Care) initiative in four states that focused on oral health integration into primary care practices located in dental shortage areas. This analysis is conducted using self-reported primary data collected from each of the participating MORE Care clinics in South Carolina, Pennsylvania, Colorado and Oregon. Three measures: the percentage of pediatric patients with a) fluoride varnish applied, b) self-management goals reviewed, and c) risk assessed, were evaluated to compare the impact and timing of change tactics on participating teams. An engagement dashboard tool was also hand coded with inductive codes using an adapted grounded theory approach common in applied health services research, to iteratively identify themes that could illuminate or explain quantitative findings. The average proportion of pediatric patients receiving fluoride varnish increased from 25 percent after the first collaborative learning session to 40 percent after the third collaborative learning session. The proportion of pediatric patients with self-management goals reviewed also improved, increasing from 25 percent to 62 percent. There was more variation in the proportion of pediatric patients with oral health risk assessments completed increasing from 47 percent to 77 percent. Qualitative analysis of MORE Care open text data produced three themes related to facilitators and barriers of project implementation and criteria for project success. The results of this analysis demonstrated that MORE Care is effective in creating an operational structure for integrating oral health care into primary care practices and most successful when participating clinics meet success criteria.

The knowledge and practice of pediatricians in children\u2019s oral health: a scoping review

BackgroundDental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to improve children’s oral health is well documented. For well over a decade, there have been calls for pediatricians to address children’s oral health, but the incorporation of oral health screening, referral, and oral healthcare in pediatric practice remains underdeveloped. Developing action to strengthen the role of pediatricians’ in children’s oral health requires an understanding of their current knowledge and practice. In this scoping review, we aimed to comprehensively map what is known about the knowledge and practice of pediatricians regarding children’s oral health.MethodsArksey & O’Malley’s five-stage review process was used to comprehensively map studies undertaken on pediatrician’s knowledge and practice regarding children’s oral health. Key search terms were developed and a total of 42 eligible articles are included in the review.ResultsThe studies were conducted in 19 countries. The majority (41/42) were quantitative, with over 90% using self-reported surveys. Only four studies used previously validated survey tools, with most adapting questions from previous studies. Observational designs were used in two studies and one used qualitative methods. Sample size ranged from 15 to 862. Oral health knowledge amongst pediatricians was reported to be mostly poor, with many gaps in key areas including age for first dental visit, dental caries and oral health risk assessments. Studies on the translation of oral health knowledge to practice were limited, with wide variation in rates of assessment. Few studies assessed actual practice.ConclusionsThis scoping review highlights growing international interest in the role of pediatricians in children’s oral health. Findings demonstrate that pediatricians have limited knowledge and understanding in critical areas, including; initial clinical signs of dental caries, recommended age for first dental visit, etiology of dental caries and recommended use of fluorides. Barriers for pediatricians include inadequate education and training, time constraints in practice and lack of referral pathways. Development of a validated tool to assess knowledge and practice is needed. This review provides a starting point to guide future research and areas for systematic reviews.

In vitro oral bioaccessibility investigation and human health risk assessment of heavy metals in wheat grains grown near the mines in North China

There is limited research on the effects of gut microbiota on bioaccessibility of heavy metals in wheat grains. In this study, bioaccessibility of heavy metals (Cu, Cd, Pb, and Zn) in wheat was determined to elucidate transfer characteristics in the soil-grain-human systems near two large-scale mining areas in Shandong Province, North China using the physiologically-based extraction test (PBET) in combination with a simulator of human intestinal microbial ecosystems (SHIME). The results showed the bioconcentration factors (BCFs) of Cu, Cd, Pb, and Zn were 0.123–0.327, 0.188–0.478, 0.019–0.099, and 0.262–0.825, respectively. Significant and positive correlations were observed between heavy metals in soils and wheat grains. In the simulated colon phase, bioaccessibility of Cd and Zn significantly decreased to 7.81% and 8.81%, respectively, being 53% and 64% of that in the simulated small intestinal phase. However, bioaccessibility of Pb showed an obvious escalating trend, being 2.4 times higher than that of intestinal incubation. Based on the estimated daily intakes and contribution, the relative high contribution of Cu to the benchmark dose in both phases, Cu metabolism by human gut microbiota should be considered in human health risk assessment regarding wheat consumption.

Primary Care and Oral Health Integration: Comparing Training Across Disciplines.

Primary care (PC) training programs must incorporate oral health (OH) into their curricula to reduce health disparities. The purpose of this study was to evaluate and compare OH education integration across multiple PC disciplines. In 2017, the authors surveyed deans and program directors (PDs) across 13 disciplines (2,245 PC programs) and used the Input Process Output framework to evaluate training factors across these disciplines. Nine disciplines represented by 767 respondents were chosen for analysis (disciplines with ³40% response rate were included). Most of the physician assistant (PA) and pediatric nurse practitioner (PNP) programs reported departmental support for OH and covered curriculum content topics on oral health risk assessment and evaluation. Similarly, over-half (>60%) PA and PNP PDs agreed that learners could answer OH-related questions on their board exams. Best practices learned from PNP and PA programs can be shared across disciplines to help bolster OH integration.

Developing oral health risk assessment as routine practice during early stages of clinical careers: A cross-sectional study of dental students using the NoMAD questionnaire.

Effective implementation of healthcare initiatives is of key importance for ensuring high-quality clinical and health outcomes. Using Normalization Process Theory, this study investigates the implementation behaviour of dental students in relation to a novel oral health risk assessment tool. It considers the impact of advancing learning on normalisation of innovative healthcare practice. Students completed the NoMAD (normalisation of complex interventions-measure development) questionnaire and an additional scale to assess perceived value of the oral health risk assessment tool, after having used the tool for nearly one academic year. The sample comprised third- (n=75), fourth- (n=77) and fifth-year (n=37) students. Differences between groups in relation to the four generative processes of normalisation were analysed using ANOVA. Cohen's d effect sizes were calculated between groups. Multiple linear regression was undertaken to investigate the impact of normalisation level on value/utility judgements. There were significant group differences for three of the four generative processes of normalisation (coherence, cognitive participation and reflexive monitoring). Third- and fourth-year students were highly similar but these groups showed lower normalisation compared to fifth years. Normalisation assessment predicted perceived value and utility of the oral health risk assessment tool. The findings suggest that dental students show lower normalisation of novel tools at earlier stages in their course, possibly due to increased cognitive load, and that perceived value and utility of a novel tool is related to increased normalisation.

Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review

BackgroundEarly childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries.MethodsA systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting.ResultsNine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children’s clinical and mother’s behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period.ConclusionsNon-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.

101. RESIDENT-LED QI INITIATIVE TO IMPROVE ASSESSMENT AND CARE OF PATIENTS WITH EARLY CHILDHOOD CARIES

Background Early childhood caries (ECC), defined as one or more decayed, missing, or filled teeth in children under 6 years, is the most common, chronic, preventable condition in childhood. ECC affects 28% of US children 2-5 years of age, particularly children of lower socioeconomic status. The American Academy of Pediatric Dentistry (AAPD) and the AAP recommend that children establish a dental home by 12 months, but lack of standardized ECC assessments and dental referral processes are often barriers to optimal care. Aim Statement In this 12- month long resident-led QI project we aimed to improve the ECC risk assessment rate for children 6 months to 6 years to 70%, and to improve the dental referral rate to 90%. Interventions The Model of Improvement was used for this QI project from December 2017 to December 2018 at a community clinic affiliated with an academic center. An electronic Oral Risk Assessment Tool was created based on AAP guidelines. Residents performed 6 plan-do-study-act (PDSA) cycles utilizing 7 interventions derived from tertiary key drivers. Measures Process, outcome and balancing measures were collected via electronic medical record review (resident documentation of EEC screening, dental referrals and developmental screening respectively). Statistical control charts were utilized to display and analyze the data. API rules were applied to detect special cause variation. Results 281 patients were screened. Oral health risk assessment improved from 37.84% to 77.74%. Initially, 72.22% of screened patients were at high risk for caries (with >1 risk factor for ECC on risk assessment tool). Over time, this rate significantly decreased to 52.46% largely due to family education. On average, 47.66% of screened patients had a dental home. Residents reached outcome goal of 90% referral rate for those patients without a dental home. Developmental screening rate, as a balancing measure, remained at 100% compliance. Conclusions and Next Steps Implementation of this QI project showed our patient population was at high-risk for ECC, which had previously been unknown, and decreased with our interventions. Creation of an electronic screening tool facilitated screening. Family education and providing a referral list of community dentists were the most successful interventions. Next steps include creating an electronic dental referral system and partnering with community dentists to enhance ECC-related family and patient education.

Oral bioaccessibility and human health risk assessment of trace elements in agricultural soils impacted by acid mine drainage

Cultivated soils around the historic mine site of Tharsis (Spain) contain elevated concentrations of As (up to 621 mg kg−1), Cu (752 mg kg−1) and Pb (2395 mg kg−1), exceeding the regional background levels and the statutory limits set for agricultural use. A site-specific health risk assessment of occupational and environmental exposures was conducted using an approach based on guidelines from regulatory agencies, refined by combining bioaccessibility and bioavailability data.Oral bioaccessibility, as determined by simulating the human digestion process in vitro (Unified BARGE Method), was largely related to total trace element concentrations in soil. Arsenic seemed to be evenly distributed among the gastric and gastro-intestinal phases (about 31%), whereas the bioaccessible fraction of pH-dependent metal cations, like Pb and Zn, was noticeably higher in the stomach (nearly 50%) than in the gastro-intestinal tract (less than 10%). Bioaccessibility assessed by single extraction with 0.43 M HNO3 was overestimated by a factor of 1.2–1.4 relative to that obtained from the BARGE method.Site-specific relative bioavailability (RBA) values of As (27.7%) and Pb (42.6%), predicted from bioaccessibility measurements through linear regression models, had little effect on the overall risk estimates. For the ingestion pathway, the RBA-adjusted cancer risk values (9.7E-05 to 2.0E-04) exceeded the regulatory threshold in all plots, and the hazard index re-calculated after adjustment of oral dose was also above the allowable limit, with values ranging from 2.5 to 4.8. However, no detrimental health effects are expected to occur through inhalation of soil particles in nearby residents.

Correlation of decayed, missing and filled teeth with risk factors for dental caries in children attending outpatient department in tertiary care hospital

Background: Oral health is of vital importance to humans’ general health. Despite the marked improvement in oral health, caries occurs in both developed and developing countries worldwide. The patient’s age is important for determining caries risk. Special attention must be paid to children’s oral health when deciduous teeth start erupting and occlusion has formed in 2 to 3-year-old children. To assess the correlation of decayed, missing and filled teeth (dmft/DMFT) with risk factors for dental caries in children and with knowledge, attitude, and practices of parents regarding dental caries.Methods: Cross-sectional study included 96 children with dental caries attending paediatric outpatient department of Government Stanley Medical College, Chennai, Tamil Nadu, India between 2018 March to November. Clinical evaluation, dmft score, and knowledge, attitude and practices of parents were assessed using pre-formed questionnaire.Results: Patients with high dmft score were found to have low practice score with the Pearson correlation coefficient(r) value -0.41 and P value was 0.01. Corresponding values of knowledge and attitude were not statistically significant. Children who nap/sleep with bottle/pacifier have increased risk (P value-0.01).Conclusions: An oral health risk assessment should be done periodically by Paediatrician who has regular contact with children for early identification of dental caries, to impart healthy oral practices and make them aware of preventive measures.

A Clinical Vignette–Based Study of Physicians’ Adherence to Guidelines for Dental Referrals of Young Children

ObjectivesThe American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age <4 years and barriers to implementation of these guidelines. MethodsA cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age <4 years was completed in 2013. The PCPs’ referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply. ResultsThe survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to >90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction. ConclusionsPCPs’ adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.

Oral bioaccessibility and health risk assessment of vanadium(IV) and vanadium(V) in a vanadium titanomagnetite mining region by a whole digestive system in-vitro method (WDSM)

Oral bioaccessibility of vanadium(IV) and vanadium(V) in soil, dust and concentrate fines from a vanadium titanomagnetite mining region was assessed by a whole digestive system in-vitro scheme. The scheme including the addition of sweat and the large intestinal digestion was used to estimate the oral bioaccessibility of vanadium(IV) and vanadium(V) in the whole digestive system for the first time. Higher oral bioaccessibility of vanadium(IV) and vanadium(V) was determined in gastric and small intestinal phases demonstrating that their major roles for vanadium digestion and absorption. The decreasing order of the oral bioaccessibility of vanadium(IV) and vanadium(V) in each digestive phase was stomach, small intestine, large intestine and mouth. Higher oral bioaccessibility of vanadium(V) in the whole digestion indicated its higher risk potential for human than vanadium(IV). Lower oral bioaccessibility of vanadium(IV) and vanadium(V) determined in bionic digestion illustrated detoxicity potential of human body for ingested vanadium. Compared with soil and dust, higher digestion rate of vanadium in vanadium titanomagnetite concentrate fines indicated its higher risk for human, especially for mining workers. Based on vanadium oral bioaccessibility, hazard quotients of the vanadium were much less than the critical level suggested for no non-carcinogenic risks to the populations surrounding the sampling sites. Indeed, compared with the estimations based on total vanadium content, the incorporation of oral vanadium bioaccessibility into risk assessments could give more realistic information.

Oral health risk assessment

Evidence shows that the use of validated risk assessment tools helps healthcare professionals to predict patients' likelihood of developing a disease with greater accuracy. Risk assessment tools have been shown to be beneficial in assisting professionals to communicate findings to patients. The psychological benefits of risk assessment tools have also been demonstrated in terms of positive behavioural change. CPD/Clinical Relevance: With the current shift towards preventive approaches to healthcare, risk assessment can assist in directing resources and prevention programmes to those patients most in need.

Promoting Oral Health in Childhood: A Quality Improvement Project.

The American Academy of Pediatrics recommends periodic oral health risk assessments (OHRAs) for young children to prevent early childhood caries and promote oral health. The objective of this quality improvement project was to incorporate OHRAs, including documentation of the oral screening examination, into well-child visits for patients aged 12 to 47 months to drive (1) improved rates of preventive fluoride varnish (FV) application and (2) improved dental referrals for children at high risk for caries. We identified a quality gap in our OHRAs, oral examination completion, FV application rates, and dental referral rates via retrospective data collection. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, oral health education, and standardization of work processes. Process and outcome measures were analyzed with statistical process control charts. At baseline, OHRAs and oral screening examinations were documented in <2% of patients. Of eligible children, 42% had FV applied. Routine dental referrals before age 3 years were uncommon. After multiple Plan-Do-Study-Act cycles, documentation of OHRAs and oral screening examinations (process measures) improved to 45% and 73%, respectively. The primary outcome measure, FV rates, improved to 86%. Referral of high-risk patients to a dentist improved to 54%. A systematic, evidence-based approach to improving oral health, including electronic medical record-based interventions, resulted in improved documentation of oral health risks and oral screening, improved rates of FV application in young children, and increased identification and referral of high-risk patients.

Geographic and health system correlates of interprofessional oral health practice

Objective This study explores geographic, system, and organizational constructs that predict medical care teams’ willingness to administer fluoride varnish and conduct oral health risk assessments. Methods A cross-sectional survey of voluntary health professionals attending trainings on interprofessional oral health practice was completed at ten meetings across the United States from April through September, 2016. Bivariate and multivariate analyses were used to examine unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations. Results A convenience cohort (n = 560) from 44 states was examined. Most (68.7%, n = 385) agreed with the dependent variable “medical providers at our site, or part of our network, are administering fluoride varnish and identifying oral health risk factors in the majority of patients seen.” In bivariate analysis, organization type (P = 0.0067), having successful referral systems (P Conclusion The dependability of medical-to-dental referral systems and processes impacts the administration of fluoride varnish and identification of oral health risk factors by motivated primary care teams. Additionally, the ease of EHR use and the availability of electronic information exchange were found to impact primary care oral health practice. Significance statement Caries activity is one of the most common diseases of childhood, and prevention/intervention by primary care teams can positively impact patient results. This analysis examined unknown correlates of oral health prevention and intervention at geographic, organizational, and system levels relating to the impact of referral mechanisms and systems as well as health information technology on fluoride varnish administration and risk-based oral evaluations.

Elevating Oral Health Interprofessional Practice Among Pediatricians Through a Statewide Quality Improvement Learning Collaborative.

Because of persistent effects of early childhood caries and impacts of dental health professional shortages areas, the integration of oral health in primary care settings is a public health priority. In this study, we explored oral health interprofessional practice (OHIP) as an integrative pathway to reduce oral health disparities. OHIP can include performing oral health risk assessments, describing the importance of fluoride in the drinking water, implementing fluoride varnish application, and referring patients to a dental home. To conduct a formative evaluation of how 15 pediatric primary care practices implemented the adoption of OHIP in their clinical settings. Using an ecological framework, we conducted a qualitative process evaluation to measure the factors that inhibited and facilitated OHIP adoption into pediatric settings. Document review analysis and qualitative interviews were conducted with pediatric practices to contextualize challenges and facilitators to OHIP adoption. A total of 15 Children's Health Insurance Program Reauthorization Act pediatric practices located in 13 South Carolina counties participated in this study. Outcomes of interest were the facilitators and challenges of OHIP adoption into pediatric primary care practices. Thematic analysis revealed challenges for OHIP adoption including limited resources and capacity, role delineation for clinical and administrative staff, communication, and family receptiveness. OHIP training for clinical practitioners and staff and responsiveness from clinical staff and local dentists were facilitators of OHIP adoption. Twelve key recommendations emerged on the basis of participant experiences within OHIP, with developing an active dental referral network and encouraging buy-in from clinical staff for OHIP adoption as primary recommendations. We demonstrated the effectiveness of a learning collaborative meeting among pediatric primary care providers to adopt OHIPs. This work reveals an actionable pathway to support oral health equity advancement for children through an additional access point of preventive oral care, reinforcement of positive oral health behaviors, and interaction between parent and child for overall health and wellness of the family.