Escalating healthcare costs and persistent disparities in outcomes have been linked to delayed engagement in preventive care and the ongoing influence of social determinants of health (SDoH). Current care models often assume that individuals can effectively manage their health and seek care at appropriate times, despite evidence that contextual constraints limit this capacity. This perspective proposes that oral health may serve as a practical and scalable entry point for earlier engagement in preventive care. Oral health problems are highly prevalent, behaviorally influenced, clinically observable, and associated with systemic health conditions. We present a six-pillar conceptual framework linking consumer-reported behaviors with clinician-observed oral health status to support risk identification, engagement, and population health strategies. The framework integrates behavioral science, predictive modeling, social risk factors, digital health infrastructure, and policy innovation. We outline a research agenda, identify implementation challenges, and discuss equity considerations. While oral-systemic relationships are well-documented as associations, further prospective and interventional studies are needed to establish causality and population-level impact.

BACKGROUND:People with disabilities may experience challenges in access to oral health care. The authors examined differences in dental care provider mix (ie, type of dental care providers visited) and dental service mix (ie, types of dental services) between working-aged adults with and without disabilities. METHODS:The authors analyzed data from the 2021-2022 Medical Expenditure Panel Survey. The sample included 10,397 adults aged 18 through 64 years who reported at least 1 dental visit in the past year. Disability status was determined from participants' responses to questions on physical, hearing, vision, or cognitive limitations. The authors estimated the rates of visiting 3 types of dental care providers (ie, general dentist, dental hygienist, and dental care specialists) and use of dental services, grouped into preventive dental procedures and treatment procedures, including restorative and endodontic, periodontic, oral surgery, prosthetic, and orthodontic. Weighted multiple logistic regression was used to estimate the association between disability status, dental service use, and dental care provider type. RESULTS:Adults with disabilities were less likely to undergo preventive dental procedures (adjusted odds ratio [AOR], 0.62; 95% CI, 0.52 to 0.74) and more likely to undergo treatment procedures (AOR, 1.45; 95% CI, 1.23 to 1.69) than those without disabilities. They were less likely to have visited a dental hygienist (AOR, 0.79; 95% CI, 0.65 to 0.95). CONCLUSIONS:According to the 2021-2022 Medical Expenditure Panel Survey data, adults with disabilities who visited a dentist were less likely to receive preventive care and more likely to undergo treatment, suggesting that oral health problems may have necessitated the dental visit. PRACTICAL IMPLICATIONS:Interventions should be tailored to disability-related needs, improve preventive dental service use, and include expanded dental insurance coverage to reduce cost barriers.

OBJECTIVES:A National Academies Consensus Study report concluded that the evidence did not support an assessment that fluoride is a neurodevelopmental hazard. However, some researchers have undertaken benchmark dose modelling to determine a safe fluoride concentration level in water. Therefore, the suitability of the data for modelling fluoride concentration in urine and water and cognition response using standard criteria was assessed. METHODS:Data quality was evaluated using a standard tool. A random-effects meta-analysis of standardised mean difference (SMD) and regression coefficients was conducted to assess effect sizes and heterogeneity. The Environmental Protection Agency (EPA) benchmark dose modelling was utilised to determine the association between fluoride concentrations and cognition scores. RESULTS:All four maternal urinary fluoride (MUF) studies did not meet the standards for acceptable quality, as identified by the EPA data quality criteria, which are necessary for combining data from different studies for dose-response analysis. The pooled estimate was not statistically significant (βMUF = -1.06, 95% CI: -3.63, 1.50; p = 0.42; I2 = 62%). A meta-analysis of five studies conducted in fluoridated areas showed a pooled SMD effect size of 0.04 (95% CI: -0.06, 0.14; p = 0.42; I2 = 0%), favoring higher fluoride. The benchmark dose models did not reveal a functional relationship between MUF or water fluoride concentration and cognitive outcomes (Goodness-of-fit p < 0.1). CONCLUSIONS:The data quality assessment revealed serious flaws that render the maternal urinary studies unacceptable for hazard assessment and benchmark dose modelling. Therefore, more appropriate studies in endemic fluorosis areas are needed to accurately determine whether fluoride is associated with adverse cognitive outcomes in populations with meaningful exposure.

Objectives:To assess disparities in unmet dental care needs between adults with and without disabilities and the reasons for not being able to get needed dental care. Methods:We analyzed data from the 2015-2018 National Health and Nutrition Examination Surveys (NHANES). The main outcome variable was unmet dental care needs (yes/no)-not being able to get dental care when needed in the past 12 months. The independent variable, disability status, was classified by whether an individual has serious difficulty in conducting any of the following six activities: hearing, seeing, mobility, self-care, cognition, or independent living. The analytical sample included 11,288 adults ages 20 years and older. We used multiple logistic regression to assess the association between disability status (measured by any disability [yes/no], six different types[yes/no], and number of disabilities) and unmet dental care needs. The differences in reasons for not being able to get needed dental care were also assessed by disability status. Data analysis accounted for the complex survey design of NHANES. Results:Adults with any disability were more likely to have experienced unmet dental needs (AOR = 1.99, 95% CI: 1.71-2.33) than those without disabilities. There was a linear relationship between the number of disabilities and higher odds of experiencing unmet dental care needs (P < .01). The top two reasons for not being able to get needed dental care were "Cannot afford the cost" and "Insurance did not cover." Conclusions:We found adults with disabilities had experienced more unmet dental needs. Further assistance including providing dental insurance coverage and mobile dental clinics is needed to help this disadvantaged population in access to dental care.

INTRODUCTION:This study examined oral health trends of older immigrants in the US from 1999 to 2018 and disparities between immigrants and non-immigrants across different races/ethnicities. METHODS:Data were from the 1999-2018 National Health and Nutrition Survey (NHANES). Outcome variables were self-reported poor oral health and significant tooth loss (i.e., < 20 permanent teeth). Participants were categorized into three groups as US natives, naturalized citizens, or noncitizen residents. The analytical sample comprised 13,424 older adults (ages 60+), including 10,087 US natives, 2280 naturalized citizens, and 1057 noncitizen residents. We assessed the trends in poor oral health and significant tooth loss across the three groups and conducted analyses stratified by race/ethnicity to examine within-group disparities. RESULTS:From 1999 to 2018, noncitizen residents consistently showed higher rates of poor oral health and significant tooth loss compared to US natives and naturalized citizens. Multiple logistic regression model results showed that naturalized citizens were less likely (AOR = 0.79, p = 0.03) to report poor oral health. Stratified analyses by racial/ethnic groups showed that among Blacks, naturalized citizens were less likely to report poor oral health (AOR = 0.59, p = 0.02) than Blacks who were born in the US. CONCLUSION:While overall oral health improved among older immigrants from 1999 to 2018, oral health disparities persisted, especially between noncitizen residents and US natives. There were significant differences in oral health between Black immigrants and their US-born counterparts. Future research is needed to corroborate these findings and monitor the trend of oral health disparities.

People with disabilities face many challenges in accessing dental care. We compared disparities in dental care patterns (ie, dental visits for preventive care or treatment) between adults with and without hearing, seeing, mobility, self-care, cognition, or independent living disabilities. We analyzed data from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Survey (NHANES). For outcome variables, we included self-reported dental visit (yes/no) and preventive dental visit (yes/no) within the past year. NHANES asked participants whether they had serious difficulty in conducting any of the following 6 activities: hearing, seeing, mobility, self-care, cognition, or independent living; participants who answered yes to any of these activities were classified as disabled. Our analytic sample included 11 288 adult respondents aged ≥20 years. We used multiple logistic regression to assess the association between disability status-measured by any disability (yes/no), the 6 types of disabilities (yes/no), and the number of disabilities-and the outcome variables, with P ≤ .05 indicating significance. Respondents with disabilities were less likely than those without a disability to have a preventive dental visit (adjusted odds ratio = 0.67; 95% CI, 0.59-0.77). Respondents with disabilities in mobility, self-care, or independent living were significantly less likely than those without any disability to have a dental visit. In addition, adults with more disabilities were significantly less likely than those without a disability to have a dental visit. Access to preventive dental care was limited among people with disabilities. Further assistance, including providing dental insurance coverage, is needed to increase access to dental care among people with disabilities, especially those with mobility, self-care, and independent living disabilities.

School-based oral health programs are an effective approach to population-based care and a stalwart of public health, especially in rural and underserved communities. Lessons learned during the COVID-19 pandemic have informed contemporary strategies and policies to ensure integration into the delicate dental safety net in the Carolinas.

Background Examination of serial cross-sectional national surveys from a representative sample of the population can identify patterns and help support policy development. Methods The authors used data from the National Health Interview Survey on US adults reporting a dental visit in the past 12 months to examine trends from 1997 through 2019. Groups analyzed were based on sociodemographic factors including residence in a metropolitan statistical area, race and ethnicity, family income level, and geographic region. Results Over the 23-year period, the authors found differences for family income level, living in a rural (nonmetropolitan vs metropolitan) area, race and ethnicity, and geographic region (P < .0001). When stratified by family income, racial disparities have diminished. Gaps in dental service use are long-standing for rural nonmetropolitan communities. Conclusions Relative to urban locales, rural communities experienced persistent disparities in the use of the oral health care delivery system throughout the 23 years measured. Strategies to create innovative models of care are needed to address oral health needs in underserved rural communities. Practical Implications Policy is needed to foster a shift toward population health that will incentivize a health care system that reduces financial barriers and enhances health outcomes for adult oral health, especially for rural areas.

Introduction: National data on dental caries and dental service use among immigrant children in U.S. are limited. It is not known whether race/ethnicity would interact with immigration status to increase these disparities. Using a nationally representative sample, this study assessed the interaction effects of immi-grant generation status and race/ethnicity on dental caries and dental visits among children in the U.S. Methods: Data were from the 2020 and 2021 National Survey of Children's Health. All data were self-reported by parents/guardians. The 2 outcomes were specialIntscript dental caries (yes/no) in the past 12 months and specialIntscript preventive dental visits (yes/no) in the past 12 months. Racial/ethnic groups included non-Hispanic White, Black, Hispanics, and Asian Americans. The analytical sample included 66,167 children aged 2-17 years, including 1,243 fi rst-generation immigrant children; 11,017 second-generation immigrant children; and 53,907 nonimmigrant children. Study authors ran separate multiple logistic regression models for the 2 outcome variables. All analyses accounted for the survey design of National Survey of Children's Health. Results: First-generation immigrant children were more likely to have dental caries than nonim-migrant children (AOR=1.44). The interaction of race/ethnicity and immigrant generation status was significant (p=0.04) in the preventive dental visits model, indicating increased challenges in getting dental visits among minority immigrant children in comparison with that among non-Hispanic White immigrant children, especially among fi rst-generation immigrant children of Asian Americans (AOR=0.41) and non-Hispanic Black immigrant children (AOR=0.37). Conclusions: First-generation immigrant children were less likely to see a dentist and more likely to have dental caries than nonimmigrants. Moreover, fi rst-generation immigrant children from minority racial/ethnic groups were the least likely to seek dental services. To further reduce dispar-ities in oral health and dental use among children in the U.S., culturally sensitive health promotion is warranted to improve oral health literacy and reduce barriers to dental care for immigrants, especially immigrant children of the minority groups. AJPM Focus 2024;3(4):100230. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background. This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 Methods. The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. Results. By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (<= 17 years) and older patients (>= 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. Conclusions. The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. Practical Implications. More efforts are needed to reduce ED visits for NTDCs.

BackgroundExamination of serial cross-sectional national surveys from a representative sample of the population can identify patterns and help support policy development.MethodsThe authors used data from the National Health Interview Survey on US adults reporting a dental visit in the past 12 months to examine trends from 1997 through 2019. Groups analyzed were based on sociodemographic factors including residence in a metropolitan statistical area, race and ethnicity, family income level, and geographic region.ResultsOver the 23-year period, the authors found differences for family income level, living in a rural (nonmetropolitan vs metropolitan) area, race and ethnicity, and geographic region (P < .0001). When stratified by family income, racial disparities have diminished. Gaps in dental service use are long-standing for rural nonmetropolitan communities.ConclusionsRelative to urban locales, rural communities experienced persistent disparities in the use of the oral health care delivery system throughout the 23 years measured. Strategies to create innovative models of care are needed to address oral health needs in underserved rural communities.Practical ImplicationsPolicy is needed to foster a shift toward population health that will incentivize a health care system that reduces financial barriers and enhances health outcomes for adult oral health, especially for rural areas.

Objectives: Previous meta-analyses have mainly focused on studies conducted in endemic fluorosis areas with relatively high fluoride concentrations. These are impoverished rural communities in China, India, and Iran, and the findings cannot be generalised to developed countries. Therefore, we investigated the association between fluoride concentrations relevant to community water fluoridation and children's cognition measured with IQ scores by synthesising effect sizes reported in observational studies. Methods: A previous meta-analysis and the National Toxicology Program database that included a search of multiple databases and the authors' search of PubMed, Google Scholar, and Mendeley provided the data. Cross-sectional and cohort studies examining the association between fluoride and children's cognition and intelligence scores were selected. Two reviewers abstracted data using standard procedures. We performed three meta-analyses to synthesise the effects using the random effects models.Results: Eight studies of standardized mean difference in IQ scores from non-endemic fluorosis areas found no statistically significant difference between recommended and lower levels of fluoride (standardized mean difference = 0.07; 95% confidence interval: -0.02, 0.17; I2 = 0%), and no significant fluctuation in IQ scores across the differences in fluoride concentrations by non-linear modeling with restricted cubic spline (P = 0.21). Meta-analyses of children's and maternal spot urinary fluoride associated pooled regression coefficients (Betachildren = 0.16; 95% confidence interval: -0.40, 0.73; P = 0.57; I2 = 0%, Betamaternal = -0.92; 95% CI: -3.29, 1.46; P = 0.45; I2 = 72%) were not statistically significant. Further regression analysis by standardizing absolute mean IQ scores from lower fluoride areas did not show a relationship between F concentration and IQ scores (Model Likelihood-ratio test: P-value = 0.34.)Conclusions: These meta-analyses show that fluoride exposure relevant to community water fluoridation is not associated with lower IQ scores in children. However, the reported association observed at higher fluoride levels in endemic areas requires further investigation. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).

BACKGROUND Population studies consistently demonstrate greater prevalence of chronic diseases, including oral diseases, among underrepresented minorities. The objectives of this retrospective study were to measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic practice-based network (PBN) in rural North Carolina. METHODS This study used deidentified electronic health record (EHR) data from adult dentate patients (≥30 years) of record (2011-2017) seeking dental care who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using CDC/AAP case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on age, gender, race, ethnicity, tobacco use, diabetes status, payer or insurance status, plaque scores, and number of teeth. RESULTS EHR data for 10,544 adult patients (60.5% female) indicated 79.8% having some form of periodontitis. This patient population was diverse: 22.6% Black, 4.4% American Indians, and 53.8% Whites, with 4.8% self-identified as Hispanic. Patients 50 years and older showed greater mean extent scores for clinical attachment levels relative to patients 30-49 years. Males exhibited greater periodontitis than females (p = 0.001). Blacks showed significantly (p<0.001) greater periodontitis prevalence relative to Whites. Hispanics also showed greater prevalence of periodontitis (p<0.001) relative to Non-Hispanics. Significantly greater periodontitis was also noted for tobacco users (p<0.001) but not for diabetes or payer status. A multiple logistic regression analysis of periodontitis prevalence confirmed significant associations for periodontitis for age, sex, race, ethnicity, tobacco use, high plaque scores, and number of teeth (p<0.001) but not diabetes or payer status. CONCLUSIONS The data document that racial and ethnic inequalities in periodontal health occur within the population of adults residing in rural communities in North Carolina and seeking dental care. SUMMARY Periodontal health disparities occur among adults seeking dental care from rural North Carolina communities with Blacks and Hispanics demonstrating greater prevalence of periodontitis relative to Whites and Non-Hispanics. This article is protected by copyright. All rights reserved.

OBJECTIVES:This project examined patterns of adult patient management using a caries risk assessment (CRA) protocol at East Carolina University, School of Dental Medicine. Usage of the CRA protocol from 2014 to 2019 was assessed. Non-operative anti-caries treatments were measured against caries risk status (high, moderate, low, or none). Steps to improve the appropriate management of patients based on caries risk are presented to align with accreditation standards for predoctoral education programs.METHODS:The CRA protocol is based on the Caries Management by Risk Assessment approach. Risk-based patterns for two non-operative interventions were examined: (1) prescriptions for 0.12% chlorhexidine gluconate (CHX) mouth rinse and (2) prescriptions for 5000 ppm fluoride toothpaste (PreviDent 5000 [PreviDent]). Statistical analyses included chi-square tests and logistic regression.RESULTS:Over the study period only 16.4% of adult patients had completed the CRA form. Among 29,411 patients from nine community sites, treatment rates for PreviDent were 18.7% among high-risk patients, 11.6% for moderate-risk adults, and 6.4% for low-risk adults (p < 0.01). Treatment rates for CHX were 23.0%, 22.6%, and 17.1%, respectively (p < 0.05). Patients without a CRA status were least likely to receive any anti-caries treatments, indicating that CRA status affects clinical, non-operative care.CONCLUSIONS:Patterns for prescription of PreviDent and CHX are consistent with CRA status. Future efforts to improve usage of the CRA protocol using faculty calibration, tracking with quality improvement tools, and reassessment. Training in the community-based educational setting is enhanced through data-based tracking to assure evidence-based decision making.

OBJECTIVE:To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM).DESIGN:This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis.SETTING:Nine dental clinic sites across the state of North Carolina.PARTICIPANTS:In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study.MAIN OUTCOME MEASURES:In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method.RESULTS:Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants.CONCLUSIONS:Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.

Background:Although there has been a slight increase in dental professionals since 2011, 98 of North Carolina's 100 counties are designated as Dental Health Professional Shortage Areas by the Heath Resources and Service Administration. This shortage significantly increases disparities and access to primary and specialized oral health care. Also, dental professionals in these remote locations may feel the access and referrals to oral and maxillofacial pathologists cumbersome. In 2020, the COVID-19 pandemic prompted an inevitable surge in the use of digital technology due to the social distancing norms and lockdowns, which forced dental education institutions and practitioners to adjust to new ways of meeting, teaching, and providing dental care. In the present manuscript, we report our institutional experience delivering specialized dental care in rural areas.Materials and methods:We conducted a retrospective case series of diagnosis, management, and outcomes of patients who underwent synchronous or asynchronous virtual and remote examination of oral lesions at ECU School of Dental Medicine and one satellite clinic over seven years. For those cases that concluded on surgical sampling, the clinical impressions, differential diagnoses, and the final diagnosis were compared to assess the accuracy of the clinical exam through teledentistry.Results:The total study population consisted of 71 patients. Most of the remote consultations were done asynchronously. Also, most virtual clinical consultations were initiated due to clinical suspicion of malignancy and infectious/reactive conditions, accounting for 42% and 25.3% of all encounters.Conclusions:The presented data suggest how teledentistry can support clinical practice in rural areas to achieve optimal care for the patient in rural or remote communities. Also, it significantly decreases the travel required, the number of appointments, and increases the speed of diagnosis. Teledentistry is an excellent tool available to all clinicians and can dramatically aid in diagnosing oral mucosa lesions.

Objective: Medicare beneficiaries in rural areas may face challenges in access to dental care. This study assessed rural–urban differences in the use of dental services and dental procedures by Medicare beneficiaries. Methods: We obtained data from the 2018 Medicare Current Beneficiary Survey cost and use files. Outcome variables examined in this study were (1) dental visits (yes/no), whether the Medicare beneficiary had ≥1 dental visit in the past year, and (2) dental procedures—preventive (yes/no), restorative (yes/no), and surgical procedures (yes/no)—whether the beneficiary had the procedure in a dental visit. The independent variable was the beneficiary’s residence (rural vs urban). We used multiple logistic regression to analyze data and accounted for the survey design of the Medicare Current Beneficiary Survey. The analytic sample included 7377 respondents aged ≥65 years. Results: Approximately 57.0% (95% CI, 54.9%-59.0%) and 46.4% (95% CI, 41.6%-51.2%) of Medicare beneficiaries in urban and rural communities in the United States had a dental visit in 2018, respectively. Rural beneficiaries were significantly less likely than their urban counterparts to have preventive procedures (adjusted odds ratio = 0.51; 95% CI, 0.36-0.72) but significantly more likely to have restorative procedures (adjusted odds ratio = 1.30; 95% CI, 1.05-1.62). Conclusion: We found significant disparities in use of dental services by Medicare beneficiaries in rural communities. When Medicare beneficiaries in rural areas used dental care, they were less likely than beneficiaries in urban areas to have preventive procedures but more likely to have restorative procedures, suggesting a greater burden of oral health needs among them. Policy research is needed to identify models that can incentivize prevention and improve access to dental care for Medicare beneficiaries in rural communities.

OBJECTIVE:To assess disparities in preventive dental service use in four major racial/ethnic groups and assess whether racial/ethnic and income-related disparities among children were reduced from 2016 to 2020.METHODS:Data were from the 2016 and 2020 National Survey of Children's Health (NSCH). The outcomes of interest were having dental sealants, fluoride treatment, and dental caries in the past 12 months. Racial/ethnic groups included non-Hispanic (NH) whites, blacks, Hispanics, Asians, and others. Family income level was categorized as below or above the 200% federal poverty level (low-income vs. high-income). Children ages 2-17 were included (N = 161,539). All data were self-reported by parents/guardians. We estimated the trends of racial/ethnic disparities in having fluoride treatment, dental sealants, and dental caries from 2016 to 2020 and tested two 2-way interactions (i.e., year by race/ethnicity, year by income) and one 3-way interaction (year by income by race/ethnicity) to assess the change in disparities from 2016 to 2020.RESULTS:Overall, no significant trends in receipt of fluoride treatment, dental sealants, or having dental caries were found from 2016 to 2020 among the racial/ethnic groups, except for a decreasing trend in dental sealants for Asian American children (p = 0.03). Overall, NH white children were more likely to have received preventive dental services than children from minority groups (all p < 0.05); Asian American children (AOR = 1.31) were more likely to have dental caries than NH white children.CONCLUSION:Disparities in receipt of evidence-based preventive services by children persisted. Continuous efforts are needed to promote the use of preventive dental services among children of minority populations.

Academic Emergency MedicineAccepted Articles RESEARCH LETTER Decline in Non-Traumatic Dental Conditions at Emergency Departments in North Carolina, 2010-2020 Mark E. Moss DDS, PhD, Corresponding Author Mark E. Moss DDS, PhD [email protected] orcid.org/0000-0003-0105-0416 ECU School of Dental Medicine, East Carolina University, Greenville, NC Correspondence contact information: Mark E. Moss, DDS, PhD, East Carolina University School of Dental Medicine, 1851 MacGregor Downs Road – MS 701, Greenville, NC 27834. Office: 252.737.7229. Email: [email protected]Search for more papers by this authorWanda Wright RN, DDS, MS, MSD, Wanda Wright RN, DDS, MS, MSD ECU School of Dental Medicine, East Carolina University, Greenville, NCSearch for more papers by this authorHuabin Luo PhD, Huabin Luo PhD Brody School of Medicine, East Carolina University, Greenville, NCSearch for more papers by this author Mark E. Moss DDS, PhD, Corresponding Author Mark E. Moss DDS, PhD [email protected] orcid.org/0000-0003-0105-0416 ECU School of Dental Medicine, East Carolina University, Greenville, NC Correspondence contact information: Mark E. Moss, DDS, PhD, East Carolina University School of Dental Medicine, 1851 MacGregor Downs Road – MS 701, Greenville, NC 27834. Office: 252.737.7229. Email: [email protected]Search for more papers by this authorWanda Wright RN, DDS, MS, MSD, Wanda Wright RN, DDS, MS, MSD ECU School of Dental Medicine, East Carolina University, Greenville, NCSearch for more papers by this authorHuabin Luo PhD, Huabin Luo PhD Brody School of Medicine, East Carolina University, Greenville, NCSearch for more papers by this author First published: 22 September 2023 https://doi.org/10.1111/acem.14807 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/acem.14807. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Supporting Information Filename Description acem14807-sup-0001-TableS1.docxWord 2007 document , 15.5 KB Supplemental Table. Policy Activity to Address Opioid Crisis in North Carolina (NC) Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation