Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement.

OBJECTIVES: To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice. DESIGN: Retrospective claims-based analysis cohort study. SETTING: Children with Medicaid insurance through an Ohio pediatric accountable care organization. PARTICIPANTS: Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017. INTERVENTION: FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider. MAIN OUTCOME MEASURE: Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes. RESULTS: The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4). CONCLUSIONS: Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.

A literature review of leadership training and a novel conceptual model of leader-member exchange theory for new dentists.

PURPOSE: The purpose of the paper is to describe the current state of leadership and leader-member exchange (LMX) theory in dentistry and develop a novel conceptual model of LMX to guide future research and highlight the importance of enhancing leadership training for new dentists. DESIGN/METHODOLOGY/APPROACH: A literature review exploring leadership in dentistry and LMX in dentistry was completed. The findings were analyzed with framework analysis to develop a novel conceptual model of LMX specific to dentistry. FINDINGS: LMX theory was applied to leadership in dentistry, including a focus on new dentists, senior dentists, other dental team members and the patient. A new conceptual model of the New Dentist LMX Quartet, which is unique and specific to new dentist teams, was developed. RESEARCH LIMITATIONS/IMPLICATIONS: The study identifies the need for research in LMX in dentistry, contributes a new conceptual model for LMX theory and identifies future research. PRACTICAL IMPLICATIONS: Practitioners, policymakers and educators can utilize this information to explore concepts in leadership and improve training and dental practice. ORIGINALITY/VALUE: No other studies specifically exploring LMX in dentistry for new dentists exist. The current literature review and conceptual paper begins the conversation on developing understanding of leadership in dentistry through further research.