Objectives:A case-control study examined factors contributing to emergency dental clinic access for nontraumatic dental conditions (ED-NTDC) among individuals residing within 20 miles of 10 networked dental clinics comprising a dental safety net. Materials and Methods:Phase I: using dental diagnostic codes for ED-NTDC visits and dental prophylaxis visits that occurred from January 1, 2019 through May 19, 2019, interrogation of an integrated medical-dental electronic health record (EHR) identified cases (n = 1784) and controls (n = 18,612), respectively, matched by dental center. Unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) and chi-squared p-values were determined using unadjusted bivariate logistic regression analysis for each demographic variable by comparing subgroup-specific proportions of cases and controls to a designated reference subgroup. Phase II: survey tools were designed and targeted to Phase I cases (n = 84) and controls (n = 113). Applying descriptive statistics, variability identified between case and control survey question responses defined additional potential candidate variables contributing to risk for ED-NTDC visits. Results:Statistically significant risk variables ORs were graphically depicted in a forest plot and included: age 18-35 (OR 1.4), 36-50 (OR 1.2), sex (male: OR 1.2), race (non-White: (OR 1.7)), payer status (self-pay: (OR 2.4); Medicaid: (OR 1.6), sliding fee: (OR 1.8)), and E-NTDC visits in medical (OR: 2.8) or dental (OR 2.0) settings in the prior 2 years. Twice-annual dental visit rates were higher among controls vs. cases. Cases vs. controls more frequently indicated: (1) a preference for pulling painful teeth; (2) dental visits were only necessary for dental emergencies; (3) delay in seeking dental care for emergent dental pain; (4) higher rates of dental fear. Economic factors, ("could not afford dental care" and "lack of insurance") especially in younger age tiers, strongly contributed to ED-NTDC visits. Conclusions:Barriers to oral health access for vulnerable populations persist. Public health initiatives targeting dental health maintenance and literacy require expansion.

OBJECTIVE The frequency of Preventable Infectious Dental Disease (PIDD) visits in medical centers was examined pre and post establishment of expanded dental access and adoption of an integrated medical-dental care delivery model. METHODS A retrospective observational study of patient attributes and frequency of unscheduled PIDD visits between January 1, 1990 and February 29, 2020. Chi-squared tests compared (a) the number of PIDD visits (pre/post dental center establishment), (b) age at first diagnosis, (c) gender, (d) race, (e) primary insurance at the time of PIDD visits and (f) healthcare setting where visit occurred. RESULTS System-wide, 21,957 unique patients were documented with a total of 34,892 PIDD visits as the primary diagnosis. Patients between 18-30 years and patients with Medicaid had the highest frequency of PIDD visits in medical settings. Following the establishment of dental centers, reduced relative risk of PIDD visits was observed for patients with no health insurance or self-pay/other coverage. PIDD visits in primary care settings was 0.87 times as likely as PIDD visits at ED/UCs after dental centers opened. CONCLUSIONS The number of PIDD visits to medical centers increased before the dental infrastructure was established, followed by a decline afterwards, inclusive of disparity populations. Some residual persistence of PIDD visits to primary care settings was identified. This study reinforced importance of dental healthcare access for achieving appropriate PIDD management while reducing PIDD visits to medical settings.

OBJECTIVES:Impact of implementing data-driven performance metric-tracking across a 10-dental center infrastructure established by Family Heath Center of Marshfield (FHC-M) was examined for relative impact on achieving value-based care delivery in serving a patient population characterized by 88% Medicaid representation.METHODS:To track progress toward national benchmarks for preventive care delivery, dental quality analytics dashboard tracking was implemented in real time with sharing of performance metrics across centers. Compliance rate with Uniform Data Systems reporting requirements for sealant placement on permanent first molars in children aged 6-9 years of age at moderate-to-high risk of caries was targeted at FHC-M dental centers for comparison with those of other community health centers statewide and nationally. Hygienist-to-dentist ratio to support robust sealant placement capacity was further examined.RESULTS:Uniform Data Systems data for rate of sealant placement between 2016-2018 revealed that FHC-M consistently exceeded rates reported statewide and nationally. For this quality indicator, performance across all dental practices in 27 states reported by Centers for Medicare and Medicaid Services in 2018 achieved 23% in 2017 compared to 73% and 52% placement rates reported by FHC-M and community health centers, respectively. A 1:1 hygienist-to-dentist was documented across FHC-M dental centers compared to 0.5:1 reported nationally.CONCLUSIONS:Implementation of quality metric dashboard and a 1:1 dentist-to-hygienist ratio supported realization of value-based dental care delivery relative to caries prevention in a moderate-to-high risk pediatric Medicaid population through achievement of robust sealant placement. Importance of adequate hygienist staffing, "same day" sealant placement and performance feedback supported by technology are highlighted.

Dr. David Satcher issued the first Surgeon General Report on oral health in the United States in 2000, drawing attention to a prevailing oral health access crisis. Dr. Satcher's report resonated in Wisconsin where a statewide growing dental access crisis was in progress and inspired grassroots efforts by a Family Health Center to establish a practice-based multi-site dental infrastructure that was integrated into a large regional multi-specialty medical clinic serving a largely rural population. An overview is provided of fundamental elements and relationships that supported establishment of the infrastructure, services, outreach and expanded access offered inclusively to all patients. Further, this community action report presents a blueprint that delineates key dimensions critical to planning and establishing a regionalized infrastructure offering access to all patients. Feasibility of establishing inclusive dental care is documented, and our model is proposed as a potentially replicable prototype for increasing dental access across other federally qualified health centers. Finally, this report is responsive to Dr. Jerome Adam's solicitations for feedback that will inform his plan for issuing a new Surgeon General report that updates status of oral health in America and progress in reversing oral health access disparities.

Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bi-directional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: (1) current cross-disciplinary practice patterns, (2) epidemiological updates, (3) status on risk assessment and screening for dysglycemia in the dental setting, (4) status on implementation of quality metrics for oral health, (5) care model pilots, and (6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oral-systemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously- and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.

An oral health surveillance platform that queries a clinical/administrative data warehouse was applied to estimate regional prevalence of periodontitis. Cross-sectional analysis of electronic health record data collected between January 1, 2006, and December 31, 2010, was undertaken in a population sample residing in Ladysmith, Wisconsin. Eligibility criteria included: 1) residence in defined zip codes, 2) age 25–64 years, and 3) ≥1 Marshfield dental clinic comprehensive examination. Prevalence was established using 2 independent methods: 1) via an algorithm that considered clinical attachment loss and probe depth and 2) via standardized Current Dental Terminology (CDT) codes related to periodontal treatment. Prevalence estimates were age-standardized to 2000 US Census estimates. Inclusion criteria were met by 2,056 persons. On the basis of the American Academy of Periodontology/Centers for Disease Control and Prevention method, the age-standardized prevalence of moderate or severe periodontitis (combined) was 407 per 1,000 males and 308 per 1,000 females (348/1,000 males and 269/1,000 females using the CDT code method). Increased prevalence and severity of periodontitis was noted with increasing age. Local prevalence of periodontitis was consistent with national estimates. The need to address potential sample selection bias in future electronic health record–based periodontitis research was identified by this approach. Methods outlined herein may be applied to refine oral health surveillance systems, inform dental epidemiologic methods, and evaluate interventional outcomes.