Preventive Oral Health Services Research Articles

Pre-Pandemic and Recent Oral and Medical Health Care Utilization among Young American Indian Children and Their Caregivers.

Children from diverse ethnic groups are at significantly increased risk for dental caries. In particular, American Indian (AI) children have the highest incidence of detal caries of any ethnic group. The COVID-19 pandemic dramatically restricted health care access, including preventive oral health care. Given this context, it is unclear whether or not preventive oral health care for AI children has resumed since lockdown. To address this question, we surveyed adult AI caregivers (N = 152) of children aged 0-5 years, assessing recent (12-month) and pre-COVID (for caregivers of children aged 3-5 years) preventive oral and medical health services. We also examined medical health care access and utilization among caregivers. Among children aged 3-5 years old, both pre-pandemic and past year medical care utilization were generally high (80 and 90%, respectively) as was any oral health care utilization (64 & 78%, respectively). Oral health check-ups were more common over the last year (62%) compared to pre-COVID (44%). Recent health care utilization among children 1-5 years old in this sample were generally comparable to national estimates, except for higher reported preventive medical care (99% vs. 87.6%, respectively) and higher preventive oral care (96% vs. 59.6%, respectively). More caregivers reported delaying or foregoing needed health care due to COVID (28-38%) versus due to cost (8-17%). In this survey of AI caregivers, recent child preventive health care utilization was high, and changes in utilization following the lockdown phases of the pandemic were comparable for oral and medical health care.

Does oral health goal setting during medical visits improve parents' oral health behaviors?

The Rocky Mountain Network for Oral Health (RoMoNOH) promotes the delivery of preventive oral health services (POHS) to children receiving care at community health centers (CHCs) in Arizona, Colorado, Montana, and Wyoming. One POHS is oral health goal setting (OHGS). This study aimed to evaluate the effect of OHGS during medical visits on parent/caregiver-reported oral health behaviors (OHBs). The RoMoNOH implementation team trained CHC healthcare providers in POHS, including caries risk assessment, oral health education, fluoride varnish application, dental referrals, and parent/caregiver oral health engagement. To promote parents' oral health engagement, healthcare providers were trained in motivational interviewing (MI) with OHGS at medical visits. To evaluate the impact of MI with OHGS on parent/caregiver OHBs, a healthcare team member invited parents/caregivers to complete a baseline survey after their medical visits. The evaluation team sent a follow-up survey after 10-14 days. The surveys measured parents/caregivers' goals, confidence in goal attainment, OHBs, and sociodemographics; the follow-up survey also measured OHGS attainment. Improvement in parent/caregiver-reported OHBs was tested with a paired t-test and unadjusted and adjusted multiple linear regression. In total, 426 parents/caregivers completed the baseline survey; 184 completed both surveys. OHBs, including toothbrushing frequency, stopping bed bottles, drinking tap water, and brushing with fluoride toothpaste improved over the evaluation interval. After adjusting for covariates, brushing with fluoride toothpaste (p = 0.01), drinking tap water (p = 0.03), and removing bed bottles (p = 0.03) improved significantly. MI with OHGS with parents/caregivers during medical visits has potential to improve OHBs on behalf of their children.

Defining quality of preventive oral health services in a northern First Nations community: a concept mapping study.

In partnership with the Norway House Cree Nation (NHCN) in Manitoba, Canada, this study developed a framework based on how Indigenous parents/caregivers of young children and community-based oral health decision-makers perceive 'quality of preventive oral health services'. Concept mapping was used to develop the 'quality of preventive oral health services' framework. This involved brainstorming/idea generation, sorting and rating, visual representation, and interpretation sessions with parents/caregivers (CG) and decision-makers (DM) in Norway House, Manitoba. Using the Concept System's GlobalMax software, a conceptual framework was created that was modified from input from CG and DM groups, which can be visualized through the concept map. The final concept map revealed seven domains of quality preventive oral health services: dental staff character and skills, working with community, responsibilities in preventive education, inclusive preventive oral health strategies, accessibility to appointments, logistics of providing services, and dental environment. This study provides insight into the existing gap in oral health services for Indigenous populations. Based on conversations and the concept mapping process, the developed framework can inform the steps to be taken to improve preventive oral health services for Indigenous peoples. The framework has been used to develop a quantitative scale to inform sustainable and impactful change in the quality of preventive oral health services that are meaningful to Indigenous peoples.

Infant oral health education curriculum for medical, nursing, and social work trainees

Tooth decay is the most common chronic disease in children, and children often see their primary care practitioners more frequently than dentists (Adjaye-Gbewonyo and Black 2019-2020; National Center for Health Statistics 2019-2020). This Infant Oral Health Education Program included two online training sessions for trainees in social work, nursing, medicine, and dentistry. Trainees were assessed on anticipated changes to their practice related to children's oral health. During the first training session, trainees received a lecture on infant oral health, and then discussed a case study in interprofessional groups to reinforce the content. Trainees in medicine and nursing completed training to receive Medicaid reimbursement for performing preventive oral health services. The second training session was profession specific with tailored instructions in the form of videos, as well as a demonstration on fluoride varnish application. Of the 78 trainees (22 social work, 4 pediatric nurse practitioner, 38 pediatric medicine residents, and 14 pediatric dentistry residents), 91 % (n = 70) reported that they were introduced to at least one new health information resource or tool. Four-fifths of the eligible trainees (n = 16/20, 80 %) who completed the evaluation had fulfilled the State's requirements to receive Medicaid reimbursement for performing preventive oral health services. Three-fourths of trainees (n = 22/29, 75 %) reported that they are likely to promote children's oral health in future clinical practice. Trainees from all four professions provided positive feedback about the content.

Effectiveness of telehealth in providing preventive oral health care: A pilot evaluation of patient, carer, and clinician experience.

This pilot study aimed to characterize the experience, satisfaction, and views on feasibility of an oral health primary prevention telehealth service at a public dental hospital's department of pediatric dentistry, from the viewpoint of patients, carers, and clinicians. Data were collected using an anonymous questionnaire for parents/guardians, a focus group for clinicians; and were summarized using descriptive statistics, chi-square tests, analysis of variance, and by thematic analysis for the qualitative data. Thirty-seven parents/guardians and four clinicians were included. The mean patient age was 5 years (SD = 3.3). Over half of the parents (51.4%) were aged 30-39 years. There was high satisfaction (97.3%) and acceptability (81.1%) of the telehealth service. Native English-speakers were significantly more likely to agree that telehealth was an acceptable mode of preventive care and that they would use it again (p = 0.033). Parents reporting difficulty traveling to dental appointments were significantly more likely to score favorably in categories of usefulness, technical quality, and satisfaction relating to telehealth (all p < 0.001). Important themes from the clinician focus group included specific benefits for patients with special needs or who live rurally, reduced stress on families, and an enhanced focus on prevention. The findings suggest ongoing benefits of providing preventive oral health services as an adjunct to face-to-face care, especially to the identified subset of patients who will benefit the most.

Prevalence of dental caries and associated risk factors among People Living with HIV/AIDS and HIV uninfected adults at an HIV clinic in Kigali, Rwanda.

Dental caries is among the most frequent oral conditions in People Living with HIV/AIDS (PLWHA). There is a lack of baseline information on dental caries prevalence and associated risk factors among PLWHA in comparison to HIV uninfected people in Rwanda. This study was conducted to determine the prevalence of dental caries and associated risk factors among PLWHA and HIV uninfected adults at an HIV clinic of Kigali Teaching Hospital (CHUK) in Kigali, Rwanda. A comparative cross-sectional study was conducted among 200 PLWHA and 200 HIV uninfected adults aged 18 years and above attending an HIV clinic of CHUK. An oral examination was performed by a calibrated examiner. Dental caries were assessed using the WHO Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Descriptive statistics, Chi-square, t-tests, and multiple binary logistic regression were used to analyze data. Overall, a higher prevalence (50.5%) of PLWHA had experienced dental caries (DMFT>0) compared to HIV uninfected counterparts (40.5%) (p = 0.045). The prevalence of Decayed teeth (D) was also higher (23.5%) among PLWHA compared to HIV uninfected persons (13.6%) (p = 0.011). The Mean(SD) DMFT scores among PLWHA and HIV uninfected participants were 2.28 (3.68) and 1.29 (2.21) respectively (p = 0.001). After performing multiple binary logistic regression analysis, the predictors of dental caries in PLWHA were being female (OR = 2.33; 95%CI = 1.14-4.75), frequent dental visits (OR = 4.50; 95% CI = 1.46-13.86) and detectable RNA viral load (OR = 4.50; 95% CI = 1.46-13.86). In HIV uninfected participants, the middle age range (36-45 years), and frequent dental visits were significantly associated with dental caries (OR = 6.61; 95%CI = 2.14-20.37) and (OR = 3.42; 95%CI: 1.337-8.760) respectively. The prevalence of dental caries was higher in PLWHA than in HIV uninfected counterparts. The reported higher prevalence of caries in PLWHA was associated with being female, detectable viral load, and frequent dental visits. Therefore, there is a need for effective oral health interventions specific to PLWHA in Rwanda to raise awareness of the risk of dental caries and provide preventive oral health services among this population. To ensure timely oral health care amongPLWHA, there is a need for an effort from policymakers and other stakeholders to integrate oral health care services within the HIV treatment program in Rwanda.

Incorporating cancer survivorship care in dental education.

Incorporating cancer survivorship care in dental education.

Prevalence of Dental Caries among 10-17 Years Old Children of a Selected School of Narayanganj, Dhaka

Introduction: Dental Caries is the most common and frequent disease affecting 60- 90% of all children across the world. Because Dental caries later results into tooth pain, discomfort, eating disorder, edentulism, delayed language development. Approximately, 80% of children attend lower secondary school so ensuring to have preventive oral health services in school would help them stay healthy and ready to learn about oral diseases. Aim of the Study: The aim of this study was to assess the prevalence of dental caries among 10- 17 years old children of a selected school in Narayanganj. Methods: This was a descriptive type of cross-sectional study conducted at ‘Fotullah Pilot High School’, Narayanganj, Dhaka on 6th February 2016. Result: In total 252 children completed the study. In our study we found that among the total 252 subjects 58 were boys and 194 were girls. Total caries prevalence was found 53.97% where 27.20% were boys and 72.79% were girls. Significant Caries (SiC) Index was found 1.89. The Global Goals for Oral Health in the year 2000 proposed to reduce the SiC index among the 12-year-olds to less than 3 DMFT by the year 2015, globally. The mean DMFT value was found 0.7 for the age group (10-17) year’s old children. We also found mandibular caries rate 67.65% is higher than maxillary caries rate 32.35%. In case of boys the maxillary caries rate 45.94% is higher than girls 28.12%. And in case of girls the mandibular caries rate 72.73% is higher than boys 54.05%. Conclusion: Dental caries prevalence in rural areas of Bangladesh is lower than that of urban population. In this study we also found it satisfactory. But as development is progressing in rural areas, consumption of fast foods &amp; chocolates is increasing day by day in rural areas as well which will increase caries prevalence in near future if oral hygiene instruction is not provided in school curriculums.

Oral Health Literacy In Young Migrant/Refugee Mothers From Developing Countries

Abstract Background and problems In the last decade, migration has increased due to climatic, economic, and social factors. Oral health is an integral part of overall health, but primary health packets for migrants/refugees often neglect oral health education and care in the care delivery system. The present article aims to present a realistic approach to integrating oral health into existing structures for young migrant/refugee mothers on a community level in Switzerland. Importance As a young child's oral health is closely related to mother's oral health status and oral health knowledge level, it would be critical that migrant/refugee mothers have access to timely oral health education and care through the primary health care system. Solution We propose an integrated oral health care model for migrant/refugee mothers that maximizes the existing primary health care system. Using existing maternal oral health resources, a training module is developed for the primary care care workforce that serve migrant/refugee mothers. This training module includes oral health needs and status assessment and delivering preventive oral health services in primary care settings. The module includes drawings and images to describe the dangers of poor oral hygiene during pregnancy related to the health of mothers and babies and how to keep the mouth healthy with low-cariogenic diet practice and home oral hygiene care. Primary health care workforce in selected migrant health centers, like nurses, medical aides, and community health care workers, is trained by this module and evaluated by a set of self-assessed questionnaires before and after the training for knowledge improvement, attainment, and clinical practice changes. Migrant mothers participate in questionnaires on oral health hygiene practice and access to dental care during pregnancy and for their young children. The questionnaires are validated by the affiliated university-hospital clinical research center.

Variation in prices for an evidence-based pediatric preventive service.

To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018). We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.

Medicaid Payment and Fluoride Varnish Application During Pediatric Medical Visits.

All Medicaid programs pay for fluoride varnish applications during medical visits for infants and toddlers, but receipt of care varies considerably across states. Using 2006-2014 Medicaid data from 22 states, this study examined the association between Medicaid payment and receipt of fluoride varnish during pediatric medical visits. Among 3,393,638 medical visits, fewer than one in 10 visits included fluoride varnish. Higher Medicaid payment was positively associated with receipt of fluoride varnish during pediatric medical visits. As policymakers consider strategies for increasing young children's access to preventive oral health services, as well as consider strategies for balancing budgets, attention should be paid to the effects of provider payment on access to pediatric oral health services.

General dentists staffing requirement based on workload in the public dental health centers in Turkey

ABSTRACT Background The Turkish healthcare system struggle with absolute shortages and imbalanced distribution of healthcare personnel. The present study aimed to measure the gap between the actual number of dentists and the ideal dentist staffing complement and evaluate the distribution of dentists among six public oral and dental health centers. Methods The workload indicators of staffing need method, developed by the World Health Organization, was used to determine the staffing requirement in these centers. Face-to-face interviews were held with 109 dentists agreeing to participate in the study. Results The results revealed the total number of actively serving dentists to be 145, the staffing requirement to be 154, and the workload to be 0.94. The actual number of dentists, therefore, needs to be increased by 6%. The most significant activities generating the workload among dentists and increasing staffing requirement were permanent tooth extraction, two-sided amalgam bonding, and fixed dental prosthesis. The number of dentists required for preventive oral health services was found to be only 4.98. Conclusion It was found high dental workload and imbalanced distribution of the participating dentists. Workload-based human resources planning may increase efficiency, effectiveness, and equality in healthcare services.

Competencies of dental public health for undergraduate students and their self-perceived achievements: The case of Iran.

The aim of this study was to develop Dental Public Health (DPH) competencies and to assess the self-perceived achievements of undergraduate students in regard to these competencies. In the first phase, by using the mixed method of the RAND-UCLA model, a list of the proposed competencies was developed and validated based on three-round expert consensus using both rating and group discussing method. In the second phase, 120senior (final-year) dental students were asked to determine their achievements based on the finalised list of competency statements on a 0-10 numerical scale. Descriptive statistical analysis was then performed using SPSS (version 22) to determine the mean score of the items and domains. Some background factors were also tested for any relationship. After three rounds of implementing the RAND-UCLA method, 31statements in 10 domains were developed and validated. The mean total score of the self-reported competency was 176.87±52.4 amongst the recruited dental students with a range of 37 to 304. The highest mean±sd score (7.7±1.8) was found for the preventive oral health services field, whilst the lowest one (4.5±2.3) was reported for understanding the components and functions of the health system. The average self-reported scores of professional ethics and professionalism, evidence-based practice and oral health determinants were also acceptable amongst them. The finalised competencies gained the consensus level of agreement and appropriateness by representatives of all DPH experts in the country. However, according to the dental students' self-reports, they had moderate competencies in most cases. Therefore, content and applied methods of training and evaluation may need to be revised to support students' development. Also, the complementary evaluation method at real work setting is highly suggested.

Oral disease burden amongst residents of an internally displaced persons camp in Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; Objective: To assess the prevalence of oral diseases and conditions amongst residents of an isolated camp that caters for internally displaced persons to define their oral health need in order to facilitate surveillance and planning of interventional programmes.&#x0D; Methods: A cross-sectional study carried out among randomly selected residents of a camp at Uhogua village forest reserve, Edo State, Nigeria. Socio-demographic data was obtained using an interviewer-administered questionnaire. Oral examination was carried out under natural illumination using mouth mirror, wooden spatula and blunt dental explorer. Oral hygiene was graded using Simplified Oral Hygiene Index. Diagnoses of caries and periodontal disease were according to the World Health Organization criteria. Clinical diagnosis of oral lesions/conditions was by visual inspection. IBM SPSS version 25.0 was used for descriptive and inferential analysis at 95% confidence interval with p set at &lt; 0.05 significance.&#x0D; Results: The mean age of the 437 study participants was 15.81 ± 8.42 with a range of 4 - 71 years. Males (43.0%), females (57.0%) and participants with primary education (78.7%). Only 3.4% of the study participants had good oral hygiene and 11.9% of the group had periodontal pockets. Dental caries prevalence was 19.7%. The DMFT/dmft index value was 0.33/0.13 with PUFA/pufa score of 0.06/0.02. However, 35.0% of permanent teeth and 79.0% of deciduous teeth had evidence of dento-oral infection and ulceration. The prevalence of oral ulcers (1.8%), leukoplakia (2.1%), erythroplakia (0.5%), oral candidiasis (5.3%), cleft palate (0.2%) and traumatic dental injury (4.3%). were noted. Lower educational attainment was associated with presence of periodontal pockets (p=0.029) and dental caries (p=0.004).&#x0D; Conclusion: Poor oral hygiene was prevalent in this group. Although the prevalence of oral diseases and conditions were low in comparison with previous local studies, many of the carious lesions had signs of dento-oral infections. Improved access to education with a significant oral health education content and preventive oral health services are recommended strategies in reducing the oral health challenges of this group.&#x0D; &#x0D; &#x0D; &#x0D;

Oral Health Among Children and Youth With Special Health Care Needs.

We sought to estimate the prevalence of oral health problems and receipt of preventive oral health (POH) services among children and youth with special health care needs (CYSHCN) and investigate associations with child- and family-level characteristics. We used pooled data from the 2016-2018 National Survey of Children's Health. The analytic sample was limited to children 1 to 17 years old, including 23 099 CYSHCN and 75 612 children without special health care needs (non-CYSHCN). Parent- and caregiver-reported measures of oral health problems were fair or poor teeth condition, decayed teeth and cavities, toothaches, and bleeding gums. POH services were preventive dental visits, cleanings, tooth brushing and oral health care instructions, fluoride, and sealants. Bivariate and multivariable logistic regression analyses were conducted. A higher proportion of CYSHCN than non-CYSHCN received a preventive dental visit in the past year (84% vs 78%, P < .0001). Similar patterns were found for the specific preventive services examined. However, CYSHCN had higher rates of oral health problems compared with non-CYSHCN. For example, decayed teeth and cavities were reported in 16% of CYSHCN versus 11% in non-CYSHCN (P < .0001). In adjusted analyses, several factors were significantly associated with decreased prevalence of receipt of POH services among CYSHCN, including younger or older age, lower household education, non-English language, lack of health insurance, lack of a medical home, and worse condition of teeth. CYSHCN have higher rates of POH service use yet worse oral health status than non-CYSHCN. Ensuring appropriate use of POH services among CYSHCN is critical to the reduction of oral health problems.

Caries Prevention in Adults- Knowledge, Attitude and Practices among Indian Dental Professionals

Background: Dentists must have accurate knowledge and affirmative attitudes about dental care in order to prevent dental caries. Therefore, the present was conducted with aim to find out knowledge, attitude and actual practices (KAP) for caries prevention in adults on Indian dentist&#x0D; Material and Methods: This cross-sectional questionnaire study was conducted on private dental practitioners of Ghaziabad city. Knowledge on preventive dentistry was assessed by 16 questions with true/false or multiple choice pattern. A total of 8 questions each were utilized for attitude and practices, respectively on a 5-point likert scale. Student’s t-test and One way ANOVA followed by post hoc test was applied to determine the relationship between mean scores of KAP and demographic variables. The significance level was set at below 0.05.&#x0D; Results: Slightly better scores for KAP was found in participants belonging to &lt;30 years of age. The total mean KAP scores of dentists were 8.9 ± 2.2, 26.1 ± 1.7, 21.1 ± 1.9, respectively. Approximately 37% dentist agreed or strongly agreed that fluoride application can prevent dental caries in adults. And 31.5% dentist never advised/performed fluoride application in high caries patients.&#x0D; Conclusion: Strategies to update dentists’ knowledge and practices of primary preventive measures for dental caries may be beneficial in promoting oral health. Findings help in emphasizing the inception and initiation of preventive oral health policies and services in the Indian scenario.

Does Education in Oral Health Competencies in Physician Assistant Education Programs Translate to Delivery of Oral Health Services in Clinical Practice?

The purpose of this study was to determine the extent to which physician assistants (PAs) are educated in oral health competencies and the relationship of education to providing oral health services to patients. The study was conducted in 2016 by administering an Internet-based survey to a nationwide sample of 2014 graduates of programs accredited by the Accreditation Review Commission on Education for the Physician Assistant. The survey response rate was 12.7% (N = 304). More than half of the PAs who received education in oral health in their professional education programs indicated that oral health curricula were either integrated into one or several topical areas in the base curriculum or delivered in stand-alone lectures. The majority of PA respondents rated their educational preparation as good or excellent in helping them provide oral health education to their patients (54.8%), make appropriate referrals to oral health providers (53.7%), and provide preventive oral health services (51.2%), while more than 40% rated their preparation as good or excellent in helping them identify oral diseases, conditions, and intervention strategies. More than one-third (35.7%) of all PA respondents reported that they provided oral health services in their clinical practices. PAs who received instruction in oral health competencies through the PA education curriculum or from other sources were 2.82 times more likely to provide oral health assessment and screening services to their patients (95% confidence interval, 1.19-6.67). The PA respondents' provision of oral health services was also significantly associated with working in primary medicine or urgent care practice specialties but not with the work setting. PAs educated in oral health competencies are more likely to provide such services to patients, especially in primary medicine or urgent care settings.

Outcomes Associated With State Policies Enabling Provision of Oral Health Services in Medical Offices Among Medicaid-enrolled Children.

To increase receipt of preventive oral health services (POHS), all state Medicaid programs have enacted policies to encourage nondental providers to deliver POHS in medical offices. This study examined if these Medicaid policies improved oral health, as measured by reductions in dental visits with treatment and preventable emergency department (ED) visits for nontraumatic dental conditions (NTDC). Using data on children aged 6 months to up to 6 years from 38 state Medicaid programs during 2006-2014, we used a generalized difference-in-differences estimation approach to examine the probability of a child having, in a year, any dental visits with caries-related treatment and any ED visits for NTDC, conditional on length of policy enactment. Models included additional child-level and county-level characteristics, state and year fixed effects, probability weights, and clustered standard errors. Among a weighted sample of 45,107,240 child/year observations, 11.7% had any dental visits with treatment and 0.2% had any ED visits for NTDC annually. Children in states with and without medical POHS policies had similar odds of having any dental visits with treatment, regardless of length of policy enactment. Children in states with medical POHS policies enacted for one or more years had significantly greater odds of having any ED visits for NTDC (P<0.05). State policies making POHS available in medical offices did not affect rates of dental visits with caries-related treatment, but were associated with increased rates of potentially avoidable ED visits for NTDC. Findings suggest that many young Medicaid-enrollees lack access to dentists.

What is the association between income loss during the COVID-19 pandemic and children’s dental care?

BackgroundThe degree to which children experience unmet need for dental care during the COVID-19 pandemic and its association with pandemic-related household job or income loss are unknown. MethodsThe authors performed a cross-sectional household survey of 348 families in Pittsburgh, Pennsylvania, from June 25 through July 2, 2020. Unmet need for child dental care and pandemic-related household job or income loss were assessed using caregiver self-report. ResultsCaregivers reported that the greatest unmet child health care need during the COVID-19 pandemic was dental care (16%), followed by medical care for a well visit or vaccination (5%). Approximately 40% of caregivers reported job loss or a decrease in household income due to the COVID-19 pandemic. The authors found a significant association between the probability of unmet child dental care and pandemic-related household job or income loss (P = .022). Losing a job or experiencing a decrease in income due to the COVID-19 pandemic was associated with unmet child dental care (relative risk, 1.77; 95% confidence interval, 1.08 to 2.88). ConclusionsIn this sample, 3 times as many households reported unmet dental care for a child compared with unmet medical care. Unmet child dental care was more common in households where pandemic-related job or income loss occurred. Practical ImplicationsIf unmet dental care continues as a result of the COVID-19 pandemic, nontraditional strategies for delivering dental care can be considered to improve access to dental care for children, such as teledentistry and oral health prevention services in primary care settings.

The Impact of COVID-19 on Preventive Oral Health Care During Wave One

Introduction: Early childhood caries burdens children, their families, and the health care system. Utilizing fluoride varnish at medical well-child visits with non-dental primary care providers can be an interprofessional strategy to combat early childhood caries. The COVID-19 pandemic dramatically altered preventive health care delivery and the effects on preventive oral health care delivery have not been previously described.Methods: This analysis used descriptive statistics and non-parametric Wilcoxon Mann-Whitney tests to compare preventive oral health utilization among 1 to 5-year old children in two state Medicaid agencies before and during the pandemic. Fluoride utilization rates at dental visits and medical well-child visits were calculated as number of users per 1,000 enrolled children. Additionally, the proportion of well-child visits that included fluoride application was calculated for each state.Results: During the pandemic, the quarterly fluoride utilization rate significantly decreased at dental visits (pre-pandemic = 153.5 per 1,000 enrolled children; pandemic = 36.1 per 1,000 enrolled children, p &amp;lt; 0.001) and signficantly decreased at medical well-child visits (pre-pandemic = 72.2 per 1,000 enrolled children; pandemic = 32.3 per 1,000 enrolled children, p = 0.03) during the pandemic.Conclusions: The findings highlight the importance of interprofessional collaboration among non-dental primary care providers and dental providers to provide access to preventive oral health services, particularly when access to dentists is limited. Future directions might include rigorous evaluations of co-located medical and dental services or the use of interprofessional telehealth technologies.