ObjectivesThe present study aimed to assess the association between family routines and dental caries and self-rated oral health status.MethodsData from the 2020–2021 National Survey of Children's Health (NSCH) completed at United States were used. Our outcome variables were self-reported dental caries (yes/no) and poor oral health condition (yes/no). Our independent variables were related to family routines: (1) Going to bed at the same time (yes/no); (2) Days having dinner together (0–7days); (3) Hours spent in front of the TV, computer, cell phone or other electronic devices (screen time); and (4) adequate sleep (yes/no). We used socioeconomic factors, health insurance coverage, family structure and neighborhood characteristics as covariates. Univariate and multiple logistic regression were used to analyze the data.ResultsFor the dental caries outcome, children with regular bedtimes (AOR = 0.68, 95% CI: 0.58–0.79), more frequent family dinners (AOR = 0.90, 95% CI: 0.85–0.96), and supportive neighborhoods (AOR = 0.88, 95% CI: 0.78–0.99) were less likely to report dental caries. Increased screen time (AOR = 1.10, 95% CI: 1.04–1.15) was associated with higher self-reported dental caries. For oral health status, children with regular bedtimes, (AOR = 0.60, 95% CI: 0.48–0.75), supportive neighborhoods (AOR = 0.81, 95% CI: 0.68–0.97), and with more neighborhood amenities (AOR = 0.92, 95% CI: 0.88–1.00) reported better health. More screen time (AOR = 1.11, 95% CI: 1.02–1.21) and poor neighborhood conditions (AOR = 1.13, 95% CI: 1.02–1.26) correlated with poor oral health.ConclusionsFindings from this study indicate that family routines play a significant role in children's oral health. Future research should focus on interdisciplinary family- and community-level interventions that are tailored to support healthy habits and address the needs of families.

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.

Social media (SM) has a high impact on everyday life, serving as a channel not only for entertainment and socializing but also for the broad dissemination of information. Oral health professionals can use SM to engage with wider audiences and have a broader impact in their communities. At the same time, dental students may refer to content on SM platforms (such as Instagram, Twitter, or YouTube) to learn and prepare for clinical procedures. However, educational content on SM is rarely evidence-based.1 Dental educators have the challenge and responsibility to capitalize on SM's benefits while minimizing risks caused by inaccurate information and noncompliance with ethical and legal standards.2 Some reported benefits of SM in dental education include enhanced student engagement, improved communication with patients and colleagues, networking, interprofessional education, patient education, health promotion, and community outreach.2-4 Reported risks comprise dissemination of inaccurate information, a negative digital footprint, privacy and/or boundary violations, poor content quality, loss of direct patient contact, use of nonsecure networks, and miscommunication.2, 4 The widespread use of SM in dental education is indisputable; however there is currently no established mechanism for quality assurance or standards for e-professionalism ("attitudes and behaviors reflecting traditional professionalism paradigms that are manifested through digital media"). Academic institutions should consider training students to critically evaluate the accuracy of information, disseminate evidence-based knowledge, and use professional standards when connecting with their patients and the community.2, 5-7 At the same time, dental school curricula should consider incorporating up-to-date, evidence-based, and peer-reviewed SM content into learning and teaching.1 The purpose of this review was to provide recommendations for creating SM policies that enhance e-professionalism and issue a Call for Action for dental schools and professional dental associations to develop a peer-review process to evaluate and validate SM content. A brief overview of several SM policies from fifteen universities was performed; surveyed institutions included, but were not limited to, those affiliated with the authors of this manuscript. Current policies and guidelines concerning SM usage in the workplace, content displayed on personal SM platforms of university employees, and guidelines for content development for educational purposes were examined. The information displayed was derived solely from online public domain. The salient points and best practices are summarized below and in Table 1A. All institutions recommend good ethical judgment as the top priority of their SM guidelines. Faculty, students, and staff are expected to follow University policies and Federal requirements, such as the Health Insurance Portability and Accountability Act of 1996 and the Family Educational Rights and Privacy Act. It is also frequently mentioned that appropriate consent must be obtained and documented before the online posting of any patient or student information and clinical photos should be de-identified. Managers and supervisors are advised to be cautious and exercise sound judgment when communicating on SM with employees, students, alumni, or others affiliated with the University. Institutional SM guidelines require respect for university property and warn against any potential harm to the Institution. Therefore, all communications on SM should be consistent with the University's policies, standards, and principles. Individuals are expected to maintain the confidentiality of the Institution's intellectual property and participate in any personal SM conversations on their own time and following the Institution's Standard Practice Guides. In addition, faculty, students, and staff should be advised to use their personal emails for nonuniversity-related business in order to maintain a clear distinction between professional and personal communications. The use of trademarks, logos, copyrighted, or other proprietary information of the University is also commonly mentioned with the general recommendation to limit their usage to university business. Students and University employees are expected to identify themselves as individuals in the community, not as spokespeople for the Institution. Anyone in a supervisory role should be extra cautious of "friending," "following," or being followed by a subordinate lest it appears as favoritism. Every user should frequently review privacy settings and access to personal information. Moreover, University employees should contact Human Resources and use caution before deciding to "cyber-vet" a staff employee, applicant, or job seeker during interviewing and hiring. In addition, cyber-vetting must be consistent with applicable law and University and department/unit policies, including, but not limited to, equal employment opportunity, recruitment and selection process, and unlawful discrimination and sexual misconduct. Some SM guidelines remark that online posts exist in perpetuity and that even if erased promptly, individuals must consider the liability to one's reputation or the Institution represented. A general best practice is to ask whether what is being posted is valuable, truthful, and accurate. Additionally, students and employees should always verify veracity before sharing a post or link from another source to avoid contributing to misinformation. Ultimately, users are reminded to correct mistakes and be open about any previous posts that have been altered. Another significant topic in University's SM guidelines addresses respect for others. Users are reminded to never make remarks that may be perceived as discriminatory, harassing, intimidating, threatening violence, or make similar inappropriate or unlawful comments. As a general best practice, users should always add a disclaimer, such as "presented views are my own, and do not necessarily represent the view or the opinions of my Institution." In the unlikely event that such content is made available, users should remove the post, take personal responsibility for the content, and apologize as necessary. The Institution may require staff, faculty, or students to remove posts that violate published policies. Despite best efforts, a post may still be perceived as unprofessional and could result in disciplinary action or termination of employment. In addition to establishing concrete guidelines for using SM within academic Institutions, there is also a critical need to ensure the dissemination of evidence-based information through these platforms. SM has been reported to promote misinformation and disseminate anecdotal evidence.8 This is particularly concerning when it relates to content that claims to have educational value. Therefore, developing and applying critical thinking skills to evaluate online content should be included as a learning objective of the dental curricula. Ask answerable questions. Access the best evidence. Appraise the evidence. Apply evidence to patient care. Assess the treatment outcomes. The Commission on Dental Accreditation (CODA), in their accreditation standards for dental education programs (https://coda.ada.org) note that "graduates must be competent in the use of critical thinking and problem-solving, including their use in the comprehensive care of patients, scientific inquiry and research methodology" (CODA Standard 2-10). In addition, CODA also emphasizes the importance of EBD and notes that "graduates must be competent to access, critically appraise, apply, and communicate scientific and lay literature as it relates to providing evidence-based patient care" (CODA Standard 2-22). Students, as future practitioners, will have access not only to increasing scientific evidence in peer-reviewed journals but also to misinformation and disinformation in "predatory" journals, which will likely be replicated in various SM and online forums. Thus, dental students must develop critical thinking skills and apply EBD strategies to critically consume online content. There are many ways to quickly detect misleading claims. For example, the "Baloney Detection" series of questions9 can be used by students as a guideline to detect the quality of the information online, including SM. The checklist encourages students to ensure the source of information is reliable and has been verified. It also emphasizes the importance of scientific evidence and identifying personal bias. Another structured framework, PROMPT,10 was developed to help students critically evaluate information. (P) Presentation: Is the information presented clearly? (R) Relevance: Does this match the actual information one is seeking? (O) Objectivity: Is this free of personal opinion and vested interests? (M) Method: Is the information collected using rigorous methodology? (P) Provenance: Is the source of information trustworthy? (T) Timeliness: Is this information up to date? Recommended guidelines on how to consume any SM content that claims to have educational value have been summarized in Table 1B. The growing popularity of SM use among dental students and the impact of such use on dental education are undoubtedly leading to a Call for Action for developing a mechanism to evaluate and validate SM content and train the next generation of dentists in e-professionalism. The inarguable right for freedom of individual expression and association, combined with the general lack of SM regulation, will always create a challenge in vetting the scientific accuracy of self-reported "educational" content on SM platforms. However, a peer-review process may, and should, still be developed. Faculty members from various Universities and key opinion leaders from professional organizations (such as the American Dental Association, specialty associations, etc.) can form SM peer-review groups or committees. SM content creators can submit their content for approval, similar to the process followed when submitting a scientific manuscript for publication in a peer-reviewed journal. Once the submitted content has been reviewed, edited as needed, and eventually approved, a "seal of approval" can accompany the SM post, indicating compliance with the peer-review process described above. If this process was to be established, SM users could start identifying content that utilizes scientific evidence and has been vetted by experts in the field. Using this process, a growing repository of validated content (posts, videos, etc.) can be created and then be used to complement the traditional dental school curriculum. Additionally, this process could provide faculty development, training, and calibration opportunities. In policy development, dental schools may refer to Table 1A and include specific examples of e-professional behavior with negative and positive impacts. In the meantime, developing a SM policy for all dental schools is highly recommended if one does not already exist. All decision-makers should be involved in the developing such policies, including students, residents, faculty, staff, patients, and the community. Most Universities are aware of the potential negative impact of SM on their Institution and its members, as well as in dental education. Many Universities have devised guidelines for SM content development and consumption. However, there is a need to educate students to be critical consumers of online healthcare information, including SM content. While critical thinking skills, and EBD, are formally taught in the predoctoral curriculum in the context of oral health care, students must also use e-professionalism, general frameworks, and known strategies to critically appraise online content. As a result of the scarcity of research on SM within the dental education literature, it is imperative that dental educators formally explore dental student outcomes, such as knowledge retention, to support best practices of SM use in dental education. Future research should investigate SM usage patterns among dental students and the extent to which the SM policies are implemented and enforced by dental school faculty and administration. Publishing the results of these studies in peer-reviewed journals will help integrate SM into the dental education curriculum. The authors would like to acknowledge Dr. Sarandeep Huja, Professor and Dean of the Medical University of South Carolina College of Dental Medicine, for his invaluable mentorship during the ADEA Leadership Institute and his instrumental feedback for the development of this project.

Journal of Dental EducationVolume 87, Issue 10 p. 1375-1376 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 87 Number 10/October 2023 First published: 15 October 2023 https://doi.org/10.1002/jdd.12993AboutPDF ToolsRequest permissionExport 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 No abstract is available for this article. Volume87, Issue10October 2023Pages 1375-1376 RelatedInformation

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

Abstract:Structural racism negatively affects the health of Black populations in the U.S. Black populations experience a higher burden of oral diseases, such as tooth decay, periodontal disease, and oral and pharyngeal cancers than other racial groups experience. Oral health literature refers to racial inequities in the context of social disadvantage. However, structural racism perpetuates those contributory social disadvantages, such as inadequate access to affordable housing, education, and employment. In addition, in states where nearly 50% of U.S. Black populations reside, there is an inequitable distribution of adult Medicaid dental benefits as well as an inequitable availability of both Black and non-Black oral health care providers. Addressing structural racism in oral health should involve commitment among stakeholders to establish awareness and equity through community-building, policy, oral health workforce development, and research.

Structural racism negatively affects the health of Black populations in the U.S. Black populations experience a higher burden of oral diseases, such as tooth decay, periodontal disease, and oral and pharyngeal cancers than other racial groups experience. Oral health literature refers to racial inequities in the context of social disadvantage. However, structural racism perpetuates those contributory social disadvantages, such as inadequate access to affordable housing, education, and employment. In addition, in states where nearly 50% of U.S. Black populations reside, there is an inequitable distribution of adult Medicaid dental benefits as well as an inequitable availability of both Black and non-Black oral health care providers. Addressing structural racism in oral health should involve commitment among stakeholders to establish awareness and equity through community-building, policy, oral health workforce development, and research.

Journal of Dental EducationVolume 85, Issue S3 p. 1909-1912 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 85 Number S3/December 2021 First published: 17 December 2021 https://doi.org/10.1002/jdd.12646AboutPDF ToolsRequest permissionExport 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 onFacebookTwitterLinked InRedditWechat Volume85, IssueS3Supplement: Advancing Through InnovationDecember 2021Pages 1909-1912 RelatedInformation

Journal of Dental EducationVolume 85, Issue S3 p. 1938-1939 ADVANCING THROUGH INNOVATION Knowledge to action: Integrating evidence-based practice into online PBL cases during COVID-19 Ramiro Mendonça Murata DDS, MS, PhD, Corresponding Author Ramiro Mendonça Murata DDS, MS, PhD [email protected] Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USA Correspondence Ramiro M. Murata, Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC, USA. Email: [email protected]Search for more papers by this authorMark E. Moss DDS, PhD, Mark E. Moss DDS, PhD Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USASearch for more papers by this authorWanda Wright RN, DDS, MS, MSD, Wanda Wright RN, DDS, MS, MSD Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USASearch for more papers by this authorVanessa Pardi DDS, MS, PhD, Vanessa Pardi DDS, MS, PhD Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USASearch for more papers by this author Ramiro Mendonça Murata DDS, MS, PhD, Corresponding Author Ramiro Mendonça Murata DDS, MS, PhD [email protected] Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USA Correspondence Ramiro M. Murata, Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC, USA. Email: [email protected]Search for more papers by this authorMark E. Moss DDS, PhD, Mark E. Moss DDS, PhD Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USASearch for more papers by this authorWanda Wright RN, DDS, MS, MSD, Wanda Wright RN, DDS, MS, MSD Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USASearch for more papers by this authorVanessa Pardi DDS, MS, PhD, Vanessa Pardi DDS, MS, PhD Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina, USASearch for more papers by this author First published: 18 March 2021 https://doi.org/10.1002/jdd.12594Citations: 6Read the full textAboutPDF ToolsRequest permissionExport 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 No abstract is available for this article. REFERENCES 1Paul R, Elder L. The Miniature Guide to Critical Thinking Concepts and Tools. Lanham, MD: Foundation for Critical Thinking Press; 2008. https://www.criticalthinking.org/store/products/the-miniature-guide-to-critical-thinking-concepts-amp-tools/156. Accessed on February 14, 2021. Google Scholar 2 Commission on Dental Accreditation. Accreditation Standards for Dental Education Programs. Chicago: Commission on Dental Accreditation; 2020. Google Scholar 3Wood DF. Problem based learning. BMJ. 2003; 326(7384): 328-330. 10.1136/bmj.326.7384.328 PubMedWeb of Science®Google Scholar 4de Groot M, van der Wouden JM, van Hell EA, Nieweg MB. Evidence-based practice for individuals or groups: let's make a difference. Perspect Med Educ. 2013; 2(4): 216-221. 10.1007/s40037-013-0071-2 PubMedGoogle Scholar 5Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990; 65(9): S63-S67. 10.1097/00001888-199009000-00045 CASPubMedWeb of Science®Google Scholar Citing Literature Volume85, IssueS3Supplement: Advancing Through InnovationDecember 2021Pages 1938-1939 This article also appears in:Advancing Through Innovation in a Challenging Time ReferencesRelatedInformation

PURPOSEThe purpose of the study was to assess the use of geofence technology to raise awareness of a dental clinic in rural North Carolina.METHODSThe catchment area of the dental clinic was defined by ZIP Codes. A geofence was identified, and cell phones within the perimeter were targeted for oral health message drops to occur over 3 months from April to June 2017. Surveys conducted twice, pre- and postintervention (message drop), evaluated change in community awareness of services available at the dental clinic. A cross-sectional analysis was used to measure the effect of the exposure to the geofence technology in survey respondents.FINDINGSThe survey included 200 participants (100 pre- and 100 postintervention). There were no significant differences in race or age for pre- and postintervention survey groups. The majority of respondents were American Indians (47.0% pre, 58.6% post) or black (28.8% pre, 25.5% post). There was a statistically significant improvement in awareness of the dental clinic (P = .045) from pre- to postintervention. A significant increase was also observed in the question related to dental visits by the respondent or family member of the respondent (from 6.5% to 15.0%, P = .04). A more modest improvement was found in questions related to the cost of dental care, type of insurance accepted, and services provided.CONCLUSIONGeofencing has the potential to increase awareness of health care services and ultimately increase the number of patients receiving care.

Background. The authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities. Methods. Data were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults >= 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix. Results. A decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values <.001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values <.001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37). Conclusions. Although preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents.

Objective: Persons with mental illness have poorer oral health and are less likely to receive oral health care than those in the general population. A comprehensive understanding of barriers to and facilitators of accessing oral health care from a multi-disciplinary perspective is lacking. The authors of this qualitative study sought to explore barriers and facilitators in addressing the oral health needs of individuals withmental illness from the perspectives of patients, psychiatrists, and dentists. Methods: A thematic content analysis approach was used to triangulate the perspectives of the three groups. Face-toface semistructured interviews were conducted in 2018-2019 with patients with mental illness (N=20), psychiatrists (N=20), and dentists (N=25) at an academic medical campus in rural eastern North Carolina. Participants were recruited until thematic saturation for each group was reached. Results: Reported barriers to oral health care were categorized under emerging themes: access to dental care, fear of dental care, characteristics of mental illness, lack of oral health screening by psychiatrists, lack of education and training, stigma of mental illness, and lack of communication. Facilitators of oral health care were linked to the reported need for education and training, financial support, dentists' chairside manner, community support, and interprofessional communication. Conclusions: The findings highlight health system gaps between oral health and mental health. The barriers and facilitators identified can help inform the development of interventions to improve oral health of patients with mental illness. Interventions should include interdisciplinary education and training, improved communication, and strategies to reduce financial barriers and anxiety in dental practice.

INTRODUCTION:The objectives of this study were to describe trends of children being given dental checkup advice by primary care providers (PCPs) and having dental visits and to assess factors associated with being given dental checkup advice and having a dental visit. METHODS:Data were from the annual, cross-sectional Medical Expenditure Panel Survey (MEPS) from 2001 to 2016. The sample included 126,773 children ages 2-17 years. We used predictive margins to estimate the probability of being given dental checkup advice and having a dental visit. We examined time trends of the proportion of children being given dental checkup advice from PCPs, as well as trends in the proportion of children having a dental visit from 2001 to 2016. Multiple logistic regression was used to assess the association between being given dental checkup advice and having a dental visit. RESULTS:Overall, the proportion of children being given dental checkup advice increased from 31.4% in 2001 to 51.8% in 2016 (Trend P < 0.001). No significant increasing trend was found for having a dental visit among those being given dental checkup advice (Trend P > 0.05). Children being given dental checkup advice were more likely to have a dental visit (AOR = 1.54, P < 0.001). CONCLUSIONS:Although there was an increase in the proportion of children being given advice to have dental checkups by PCPs from 2001 to 2016, there was no significant increase in having a dental visit among children being given the advice. More research is needed to better understand how dental care advice from a PCP can effectively motivate and facilitate dental care for children.

Oropharyngeal cancer has become the new face of HPV-related cancers, and this alarming growth highlights the pivotal role dentists can play in prevention. This study aims to identify current HPV-related curricula taught across US dental schools and evaluate HPV health literacy and intention to engage in HPV prevention among US dental students. The dental school curricula included responses from 40 Academic Deans (61% response rate). The 4-item survey focused on understanding HPV-related content in dental school curricula and was administered via Qualtrics. A 31-item paper survey was administered to dental students (N = 109) at a southeastern dental school assessing HPV health literacy, scope of practice, willingness to administer HPV vaccine, self-efficacy in HPV prevention, and basic demographics. Data were collected between February and May 2018. Over 40 courses were identified and included HPV-related content in multiple disciplines including oral and general pathology, immunology, oral medicine, microbiology, infectious diseases, public health, and oral health management among others. Among dental students, over half were female (61%), non-Hispanic White (61%), with a mean age of 26 and in their first (48%) or third year of dental school (52%). Results indicate some HPV knowledge gaps. Most dental students believe HPV prevention is within their scope of practice; however, 56% reported feeling somewhat/not at all confident in recommending the vaccine and performing oral cancer exams. Our data supports the timeliness and need to strengthen HPV-related content in dental school curricula to effectively train and engage future dental providers in HPV prevention.

Abstract Introduction: Medical and dental care are largely siloed, making it difficult for these culturally, financially, and educationally different health care professionals to work together to provide comprehensive care. Engaging dentists in HPV-related prevention activities may be a meaningful strategy to reduce HPV-related morbidity and mortality. Therefore, effective prevention strategies coupled with systems-level strategies could improve interprofessional approaches in HPV prevention. We sought to assess HPV health literacy and intended HPV vaccination recommendation and communication practices among future health care providers. Methods: A 31-item survey for dental students and 25-item survey for medical students assessing HPV and HPV vaccine knowledge, willingness to administer HPV vaccines, self-efficacy in engaging in preventive efforts, and basic demographics was administered to students from a southeast School of Dental Medicine and School of Medicine. Surveys were administered in Spring 2018 for dental students (N=109) and Spring 2019 for medical students (N=105). Results: Dental students’ sample was 61% female, mean age of 25.79 (SD=3.31), 61% white, 48% 1st year and 52% 3rd year. Medical students’ sample was 51% female, mean age of 25.18 (SD=3.31), 58% white, 71% 1st year and 29% 2nd-4th year. Among our sample, 62% of dental students self-reported receiving the HPV vaccine (30% completion rate) and 56% of medical self-reported being vaccinated (22% completion rate). The majority (67%) of dental and medical students did not know most HPV infections clear up on their own within 2 years and that HPV-related OPC is higher among men as compared to women (66% of dental; 78% of medical students). In regards to vaccine knowledge, 54% of dental students were not aware of the recommended 2-dose administration and 45% of medical students were not aware of vaccine recommendations for gay, bisexual, and other men who have sex with men, transgender people, and for immunocompromised persons. When asked about perceived self-efficacy in engaging in HPV preventive efforts, 42% of dental students anticipated having an uncomfortable conversation with patients when recommending the HPV vaccine, 43% did not feel confident in performing oral cancer exams, 56% did not feel confident in recommending the HPV vaccine, and 66% did not feel confident in talking about HPV risk factors. Among medical students, 27% anticipated having an uncomfortable conversation with patients when recommending the HPV vaccine, 29% did not feel confident in recommending the HPV vaccine, and 37% did not feel confident in talking to patients about HPV risk factors. Final analysis will be presented at conference. Conclusion: This study can improve our preliminary understanding of interprofessional training opportunities for effective systems-level strategies to improve bidirectional access and communication across oral health and primary care to engage in effective HPV prevention across professions. Citation Format: Essie Torres, Alice Richman, Wanda Wright, David Eldridge, Luan Lawson. Evaluating medical and dental students’ human papillomavirus-related cancer knowledge and perceived self-efficacy in HPV vaccine communication and recommendation practices [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D028.

PURPOSETo assess rural-urban differences in dental service use and procedures and to explore the interaction effects of individual- and county-level factors on having dental service use and procedures.METHODSData were from the 2016 Medical Expenditure Panel Survey (MEPS). We assessed rural-urban differences in 3 outcome variables: number of dental visits (1, 2, or 3+ visits), preventive care procedures (Yes/No), and treatment procedures (Yes/No). The study sample included 8,199 adults ≥ 18 years of age who reported at least 1 dental visit in the past year. Sampling weights embedded in MEPS were incorporated into all the analyses.FINDINGSA significant interaction between residential location and race/ethnicity (P = .030) suggested limited access to dental visits for minority groups, especially for blacks in the more rural areas. Adults from a more rural area were less likely to have received a preventive procedure (AOR = 0.55, 95% CI: 0.35-0.87) than those from an urban area. Adults of racial/ethnic minority groups, with lower SES, and without dental insurance were less likely to have received a preventive procedure (all P < .01) but were more likely to have received a treatment procedure (all P < .05).CONCLUSIONSThe study showed rural adults were less likely to have received preventive dental procedures than their urban counterparts. Racial/ethnic minority groups living in a more rural area had even more limited access to dental services. Innovative service delivery models that integrate telehealth and community-based case management may contribute to addressing these gaps in rural communities.

Maldistribution of the dental workforce contributes to poor access to oral health care. Community-based dental education (CBDE) may help to address this problem by using experiential learning to encourage new dentists to practice in underserved areas. The East Carolina University School of Dental Medicine (East Carolina University SoDM) employs a multifaceted strategy, including CBDE, to increase the number of dentists practicing in underserved areas of North Carolina. The aim of this study was to assess the influence of CBDE and other factors on practice choice among East Carolina University SoDM graduates. This cross-sectional study assessed practice intentions before and after a senior-year CBDE experience. Data were obtained for students in three graduating years from written student reflections and self-reported practice plans solicited at graduation. Of the total 156 students between 2015 and 2017 (52 each year), all students participated in at least one component of this evaluation: all students (100%) completed required student reflections, and 148 (95%) provided pre-graduation practice plans. Data were also obtained on alumni practice characteristics via a survey of recent graduates; 72 alumni (46% response rate) participated in the alumni survey. The assessments found positive attitudes towards the CBDE program before and after participation, although areas for improvement relating to business management and financial viability were reported. The majority of alumni respondents (67%) remained in the state to practice after graduation, with half reporting practicing in rural areas. For most alumni respondents (>75%), debt, salary, benefits, type of patient population, and desire to own/run a business were important factors other than the CBDE program influencing their practice choice. Nearly half of them (45.8%) rated desire to work in a public health setting as an important factor. This study provides preliminary evidence of the effectiveness of this educational model in retaining new dentists within the state to address the critical shortage of dentists in North Carolina.

Background. The authors assessed the trends of annual dental visits in dentate adults with diabetes or prediabetes or no diabetes, and assessed whether the racial and ethnic disparities in dental visits changed from 2004 through 2014. Methods. Data for this analysis came from the Behavioral Risk Factor Surveillance System, a US health survey that looks at behavioral risk factors that was developed by the Centers for Disease Control and Prevention in cooperation with state health departments. Respondents indicated whether they had a dental visit in the past 12 months. Weighted proportions were calculated for annual dental visits in adults by diabetes status, and trends were assessed by racial and ethnic groups. Results. From 2004 through 2014, the proportion of annual dental visits declined from 66.1% to 61.4% (trend P = .02) in the diabetes group, 71.9% to 66.5% (trend P = .01) in the no diabetes group, and 66.0% to 64.9% (trend P = .33) in the prediabetes group. Age, income, and health insurance were moderators of the association between diabetes status and dental visits. Overall, the racial and ethnic disparity in dental visits did not change significantly during the period. Conclusions. Dental visits and services were less frequent in people with diabetes and prediabetes. Racial and ethnic disparities in use of dental services persisted during the observed period. Practical Implications. All patients, especially those with diabetes, are encouraged to visit a dentist at least annually. It is important for health care providers, such as primary care physicians and dental care and public health professionals, to make concerted efforts to promote oral health care in diabetes management. Improving access to dental services is vital to achieving this goal.

Every year, cigarettes and other tobacco products cause nearly one in five deaths in the U.S., but many smokers report not being advised to quit by their health care providers. Dentists have an important role to play in tobacco cessation, but more research is needed about the extent of and barriers to implementation in dental practices. The aims of this study were to assess the extent to which dental practices in northeastern North Carolina were implementing the recommended U.S. Public Health Service (PHS) Clinical Practice Guideline, to understand policies about smoking in dental practice settings, and to identify barriers to implementation of recommended systems. In the 252 telephone area code, which covers northeastern North Carolina, 75 general dentists were identified from the American Dental Association website and purposely selected for geographic, gender, race, and practice size diversity from the sampling frame. The 11 dentists who agreed to participate (seven male, four female) took part in 15-minute semi-structured interviews by phone in January-March 2017. The interview transcripts were thematically coded for adherence to the PHS guideline. The results showed that full implementation of the guideline and the 5As was limited, although asking, advising, and assessing about tobacco use was consistently present in these dental practices. Other recommendations, particularly designation of a staff member as coordinator, were not implemented. In terms of barriers, interviewees reported very limited past or present training for themselves or their staff members. This study found meaningful levels of adherence to the tobacco cessation guideline in this area with high smoking prevalence; but the results suggest room for improvement in training through both dental curricula and continuing education.