Fluoride effectiveness in high caries risk and medically complex Veterans.

BACKGROUND: The Global Burden of Disease Study showed there was a 34.5% increase in years lived with disability due to dental caries from 1990 to 2010. With the aging of 76 million baby boomers, dental caries will continue to pose a significant challenge for older adults. OBJECTIVE: Test the effectiveness of prescription or professionally applied fluoride in the prevention of new dental restorations in a clinical setting where patients are medically compromised and more dentally impaired than the general population. METHODS: A retrospective cohort study, using multiple electronic databases within the Department of Veterans Affairs. Propensity scores were used to adjust for confounding by indication and logistic regression modeled the outcome and included all expected covariates. RESULTS: The study sample included 140,114 high caries risk Veterans with a mean of 3.4 physical comorbidities, 1.2 mental comorbidities, and 11 medication groups per patient. Patients who received clinical fluoride treatments had 17-20% decreased odds of requiring a restoration during the follow-up period. CONCLUSIONS: Prescription self-applied or professionally applied fluoride provided either before or during an episode of care significantly reduced the likelihood of new restorations in high caries risk and medically compromised Veterans.

Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries.

BACKGROUND: Staff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past. METHODS: In a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM. RESULTS: In 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period. CONCLUSIONS: Fluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation. Practical Implications Fluoride use reduces the need for future restorations in adults at high risk of experiencing caries.

Leading determinants of efficient dental care delivery.

OBJECTIVE: Identify structure and process variables that significantly contributed to dentist productivity across VA Dental Service clinics using multiple VA national datasets from fiscal year 2010. METHODS: A retrospective, longitudinal analysis with the primary outcome of care provided, as measured by relative value units per clinically mapped full-time employee equivalent dentist, per year. Predictor variables included physical plant variables, staffing variables, complexity of the patient population, workplace climate, and environment of care. Predictor variables were initially assessed in a bivariate analysis with the primary outcome and those significant at P < 0.2 were entered into an ordinary least squares regression model. RESULTS: Dentist productivity and several predictor variables were significantly different between sites with and without resident training programs; therefore, two explanatory models were constructed. In both models, increasing the assistant-to-dentist ratio was the most important driver for increasing productivity. Additional drivers include the resident-to-dentist ratio, use of technology, and connectedness and engagement with the medical center as demonstrated by participation in various committees and/or boards. Final models explained over 50 percent of the variance in productivity. CONCLUSIONS: In multiprovider settings, predictors of dentist clinical productivity differ for sites with and without residency training programs. Although the assistant-to-dentist ratio is the most explanatory for each type of setting, other variables such as the resident-to-dentist ratio, use of technology, and connectedness/engagement with the medical center are uniquely significant to the two types of service sites and should also be considered to maximize productivity.

Factors associated with the satisfaction of millennial generation dental residents.

Data from the 2010 Learners' Perceptions Survey (LPS) administered through the Office of Academic Affiliations, Department of Veterans Affairs (VA) were analyzed to identify factors associated with dental residents' satisfaction with the VA as a clinical training environment. Satisfaction scores were linked to clinic workloads, dental procedure complexity levels, staffing patterns, and facility infrastructure data to explore conditions that may improve residents' satisfaction. Findings supported the construct validity of the LPS survey data and underscored the importance of maintaining optimal ratios of attending dentists, dental assistants, and administrative staff to residents so that each trainee will have opportunities to perform an adequate level of dental workload. As programs strive to improve the quality of graduate dental education, findings from this study are vital for setting curriculum design guidelines and for providing infrastructure support for dental resident education.

Impact of infrastructure on graduate dental education and dental clinic productivity.

Using all-inclusive data from 126 U.S. Department of Veterans Affairs health care facilities that provide dental services, this study identified the staffing infrastructure under which the Veterans Health Administration can provide graduate dental education without compromising dental clinic productivity. From regression analyses, we found that teaching residents has a negative impact on staff dentists' productivity; however, when the dental assistant to provider ratio is greater than or equal to 1.0, dental residents' workload contribution can offset the negative impact on overall clinic productivity. In the presence of dental residents, the dental assistant, front-desk personnel, and dental treatment room to provider ratios have a positive impact on productivity. The optimal ratios were calculated as 1.5 for dental assistants, 2.1 for dental treatment rooms, and 0.57 for front-desk personnel.