Functional Oral Health Literacy and Periodontal Health.

Purpose: Growing evidence associates low oral health literacy (OHL) with poor oral health outcomes. While nearly half of United States adults have periodontal disease (PD), there are conflicting results on association between OHL and PD. The purpose of this pilot study was to explore the association between functional OHL and periodontal health as defined by the American Academy of Periodontology (AAP) classification system.Methods: A cross-sectional study was conducted with a convenience sample of dental patients presenting for care at a Midwestern Federally Qualified Health Center. Functional OHL was measured using the Oral Health Literacy Adults Questionnaire (OHL-AQ), and periodontal health was measured clinically and categorized by stage and grade using the recently revised AAP classification system. Additional demographic factors and health history information related to periodontal health were collected. Descriptive analysis reported the median and range for ordered variables, and frequency and percentages for categorical variables. Wilcoxon rank sum test, Kruskal-Wallis test, and Spearman correlation coefficients were used to find association between functional OHL and periodontal health.Results: Among fifty-four participants, statistically significant associations were found between OHL-AQ scores and AAP staging and grading categories. Periodontal disease stage increased with age, and periodontal disease grades progressed among participants with diabetes. No associations were found between periodontal health and sex, race, ethnicity, education, insurance, or country of origin.Conclusion: Functional oral health literacy had a significant inverse relationship with both AAP periodontal disease staging and grading. A larger study is needed to confirm the findings of this pilot study.

DENTAL THERAPY AND DENTAL PATIENT-REPORTED OUTCOMES (dPROs).

Dental therapy was introduced into the dental team as an advanced practice provider with the intention to increase access to care while providing high quality care in a cost-effective manner. It is essential that the dental therapist is able to provide patient-centered care to minimize patients' suffering. In order to assess patients' suffering, it is critical to understand the impact of care and dental patient-reported outcomes (dPROs). The use of dPROs in evidence-based clinical practice can assess the impact that the advanced practice provider has in dentistry. The presence of dPROs in evidence-based clinical practice will show the equivalence and differences in impact of the dental therapist and dentist. Currently, there is limited research regarding the use of dPROs in dental therapy. A roadmap in this paper demonstrates possible ways to collect dPROs in dental therapy and advance evidence-based dental practice. Recommendations in ways to achieve the roadmap, possible research designs, and expansion in knowledge of dental therapy and dPROs are provided. It is important to explore the advanced practice provider and the possibilities in evidence-based dentistry with the usage of dPROs.

A comparison of dental therapy and dental students' clinical performance.

The aim of the study was to determine if there is a difference between dental therapy students' clinical performance as compared to dental students at the University of Minnesota. An ex post facto research design was used to compare dental therapy students' and dental students' performance on selected clinical procedures. Dental students and dental therapy students from the graduating classes of 2016, 2017, and 2019 at the University of Minnesota comprised the study sample. Fisher's exact test was used to compare pass rates, and Wilcox rank sum test was used to compare performance scores. Dental therapy students' clinical performance on competency examinations and scores on daily clinical procedures showed no statistically significant difference when compared to dental student performance. There was no overall statistical difference in clinical performance between the three student cohorts. Dental therapy students performed equally as well as the dental students.

Item and scale properties of the Oral Health Literacy Adults Questionnaire assessed by item response theory.

OBJECTIVES: a) To evaluate the item and scale properties of the Oral Health Literacy Adults Questionnaire (OHL-AQ) in an adult general population. b) To determine precision or accuracy of the respondents' estimated scores along the Oral Health Literacy (OHL) spectrum using item response theory (IRT) modeling. METHODS: Survey data were collected from a convenience sample of 405 adult attendees of the 2014 Minnesota State Fair. We used the two-parameter logistic (2PL) model for the item response theory (IRT) analyses of OHL-AQ data and calibrated items to estimate model-based item difficulty and discrimination parameters. Item and scale properties were also assessed by plotting and interpreting item characteristic curves (ICCs), test characteristic curve (TCC), and test information function (TIF). RESULTS: Based on interpretation of model coefficients, statistical testing, and model fit criteria, we deemed the 2PL model superior and selected this model to examine item and scale properties. Scale reliability was shown to be good through the test information function (TIF). TIF from our analysis showed that higher levels of OHL were measured less precisely than lower levels of OHL. CONCLUSION: We demonstrated OHL-AQ as a whole has promising psychometric properties. However, for equiprecise measurement across the scale range, the scale needs more items for measuring higher levels of OHL.

Introducing and Evaluating Intraprofessional Team-Based Care Delivery in a Dental School Clinic: A Pilot Study.

There is growing interest in developing more efficient, patient-centered, and cost-effective models of dental care delivery using teams of professionals. The aims of this small pilot study were to assess the number of patient visits, type and number of procedures performed, and clinic revenues generated by an intraprofessional team of dental, dental hygiene, and dental therapy students and to determine the students' and patients' perceptions of this model of care. Sixteen senior students from three student cohorts (dental, dental hygiene, and dental therapy) at the University of Minnesota piloted a team-based dental delivery model from January to April 2015. The group was named the Team Care Clinic (TCC), and the team for each clinical session consisted of one dental student, three dental hygiene students, and one dental therapy student. Data were collected from the school's database to determine the number of patient visits, type and number of procedures performed, and clinic revenue generated by the TCC. Focus groups were used to assess student perceptions of the experience, and patient satisfaction surveys were administered to assess the patients' experience. The TCC students were given twice as many patients as non-TCC students, and they managed them effectively. Working as a team, the TCC student providers completed twice as many procedures per patient encounter as non-TCC students. Patients and students said their experiences in the TCC were positive, and students expressed a preference for team-based care delivery. The results of the study suggest the team-based dental care delivery model is promising. Team-based care delivery may allow providers to accomplish more during a patient appointment and increase provider satisfaction.

Influence of Socioecomomic and Oral Health Status on Acceptability of Dental Therapists' Oral Health Care.

This study explored the acceptability of dental therapists by respondents' socioeconomic factors and oral health status. METHODS: Data were collected from 405 adults during the 2014 Minnesota State Fair through completion of an electronic questionnaire and a modified Basic Screening Survey (BSS). RESULTS: This study found no relevant and statistically significant relationships between a respondent's various socioeconomic factors and their acceptability of care provided by a dental therapist. It also demonstrated no association between participants' perceived or physical oral health status and their acceptability of care provided by a dental therapist. CONCLUSIONS: The acceptability of care provided by a dental therapist is neither related to socioeconomic characteristics nor perceived or physical oral health. PRACTICAL IMPLICATIONS: While advancing the acceptability of dental therapists faces many challenges, the patient's socioeconomic profile and his/her oral health status are not among them.

Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Dental School Faculty Attitudes Toward Dental Therapy: A Four-Year Follow-Up.

This study is a follow-up to a 2010 study at one U.S. dental school that found faculty attitudes toward the dental therapy model were mixed and there was a clear divide in attitudes between faculty members who were full-time educators and part-timers who also practiced outside the educational institution. The aim of this study was to determine faculty attitudes toward and perceptions of the dental therapy model at the same school four years after implementation of the dental therapy program. The identical questionnaire used in 2010 was used in this survey conducted from November 2013 to January 2014. All 254 full-time and part-time faculty members were invited to participate; responses were received from 75 faculty members, for a 30% response rate. Four years after the initial survey, the respondents showed greater acceptance of dental therapists and of dental therapy as a mechanism for addressing access to care problems. A majority of the respondents reported feeling a personal responsibility to ensuring the dental therapy model succeeded (52%); indicated being comfortable having a dental therapist provide care for their patients (60%); and agreed that the ability to delegate work to a dental therapist would make a dentist's job more satisfying (54%). Faculty members who also worked in a private practice viewed the role of dental therapists in private practice more favorably in 2014 than in 2010. This study provides insight into how attitudes of educators toward a new profession evolve over time. The faculty appeared to be undergoing a reorientation on the topic of dental therapy. This transition in point of view may have been facilitated by factors such as continued exposure to the new professionals, information sharing, and time.

Validation of the English-language version of 5-item Oral Health Impact Profile.

PURPOSE: The Oral Health Impact Profile (OHIP) is currently the most widely used oral health-related quality of life (OHRQoL) instrument. The study validated the English-language 5-item OHIP by investigating its psychometric properties of dimensionality, reliability, and validity in the adult general population. METHODS: In 405 subjects (mean age 45+15.7 years, 63% female) from the 2014 Minnesota State Fair, dimensionality was investigated by confirmatory factor analysis. Construct validity was assessed by using a structural equation model correlating OHRQoL and self-reported global oral health status. Reliability was calculated using Cronbach's alpha for OHIP5 total scores. RESULTS: In the confirmatory factor analysis, the unidimensional model fit OHIP5 well as indicated by fit indices (RMSEA: 0.07, SRMR: 0.03, comparative fit indices: >0.95). In the structural equation model, self-reported global oral health status correlated with 0.46 with the latent OHRQoL factor, indicating sufficient construct validity. Cronbach's alpha, a measure of score reliability, was "satisfactory" with 0.75. CONCLUSION: We validated the English-language version of OHIP5 in the adult general population. Ultrashort instruments such as the 5-item OHIP provide a conceptually appealing and technically feasible opportunity to measure the impact of oral disorders and dental interventions in settings such as general dental practice where the burden to collect and interpret OHRQoL information needs to be minimized.

Dental therapy: evolving in Minnesota's safety net.

OBJECTIVES: We identified Minnesota's initial dental therapy employers and surveyed dental safety net providers' perceptions of dental therapy. METHODS: In July 2011, we surveyed 32 Minnesota dental safety net providers to assess their prospective views on dental therapy employment options. In October 2013, we used an employment scan to reveal characteristics of the early adopters of dental therapy. RESULTS: Before the availability of licensed dental therapists, safety net dental clinic directors overwhelmingly (77%) supported dental therapy. As dental therapists have become licensed over the past 2 years, the early employers of dental therapists are safety net clinics. CONCLUSIONS: Although the concept of dental therapy remains controversial in Minnesota, it now has a firm foundation in the state's safety net clinics. Dental therapists are being used in innovative and diverse ways, so, as dental therapy continues to evolve, further research to identify best practices for incorporating dental therapists into the oral health care team is needed.

Dental school faculty perceptions of and attitudes toward the new dental therapy model.

The University of Minnesota School of Dentistry launched its new dental therapy program in September 2009 after the Minnesota state legislature had authorized the training and practice of a dental therapist in May of the same year. The creation of this mid-level dental provider is seen as a workforce solution to help address the problem of access to dental care experienced by some members of our society. However, there is a lack of consensus and even controversy in organized dentistry about dental therapy, one of the mid-level provider models. This study explored the attitudes and perceptions of dental school faculty members who have been tasked to prepare these new dental therapists to do their work. Focus groups were conducted with a randomly selected group of faculty members, the results of which were used to develop a survey of faculty members in all departments of the school. A total of 151 faculty members responded to the survey: 68 percent of these respondents were fifty-one years of age or older; 79 percent were male; and 39 percent were full-time and 61 percent part-time. Fifty-four percent were clinical faculty members, and the rest taught in the preclinical courses and basic sciences. The study found that these dental faculty members believe dentists have a personal responsibility in the care of the underserved but do not agree that the dental therapists are part of the solution to improve access. There was a clear divide between the part-time faculty members, who practice outside the institution, and the full-time educators with regard to the role of dental therapists. However, there was an overall consensus that dental faculty members have a commitment and responsibility to educate future dental therapists regardless of their personal position. This is encouraging to dental therapy students, who can be assured that they will receive the education they need to prepare them to practice.

Factors associated with reported need for dental care among people who are homeless using assistance programs.

A retrospective secondary data analysis of the National Survey of Homeless Assistance Providers and Clients database was conducted to identify the demographic characteristics and correlates associated with reported need for dental care among people who are homeless in the United States. Overall, 10% of people who were homeless reported that dental care was their most needed service. Of these, 17% had a dental visit within the previous 12 months, 52% were racial/ethnic minorities, 76% lived in a central city, and 26% were veterans. The unadjusted odds for reporting a need for dental care was highest among veterans who were homeless and those whose last dental visit occurred more than 12 months ago. Compared to nonveterans who were homeless, veterans had twice the adjusted odds for reporting a need for dental care. The adjusted odds for reporting a need for dental care were lowest for those with dental insurance. Evaluation of the data suggests that dental insurance was associated with reporting lower need for dental care. Veterans who were homeless reported higher odds for dental care. Strengthening existing oral health-care programs sensitive to the needs of people who are homeless may improve their oral health and reduce their dental-disease-related morbidity.

Developing a tool for systematic inclusion of non-academic factors in dental school admissions: towards building diversity in the dental workforce.

This retrospective study aimed to determine the ability of a self-designed evaluation instrument to identify applicants who should be invited for an interview and to assess applications including non-academic factors in a consistent and systematic manner. The instrument was constructed using information culled from the American Dental Education Association Associated American Dental Schools Application Service (ADEA AADSAS) applications including academic (DAT, GPA) and non-academic qualifications (work experience, volunteer and extracurricular activities, rural and ethnic background, essays). Weights were assigned to each item assessed. Using applications received during the 2006 and 2007 admissions cycles, the instrument identified who should have been invited for interview. Descriptive statistics and specificity and sensitivity tests were conducted. The instrument allowed for a systematic quantitative assessment of non-academic factors that was part of the overall evaluation of applicants. Results show differences in non-academic scores of minority compared to non-minority applicants, males compared to females, and those who were offered interviews compared to those not interviewed. It is possible that some applicants who were not offered interviews could have gained a chance to be looked at more closely on a second round of review if non-academic factors were considered.

Racial/ethnic disparities in the acceptance of Medicaid patients in dental practices.

OBJECTIVES: Medicaid enrollees disproportionately experience dental disease and difficulties accessing needed dental care. However, little has been documented on the factors associated with the acceptance of new Medicaid patients by dentists, and particularly whether minority dentists are more likely to accept new Medicaid patients. We therefore examined the factors associated with the acceptance of new Medicaid patients by dentists. METHODS: We analyzed 2001 data from the Wisconsin Dentist Workforce Survey administered by the Wisconsin Division of Health Care Financing, Bureau of Health Information. We used descriptive statistics and logistic regression analysis to examine the factors associated with the outcome variable. RESULTS: Ninety-four percent of Wisconsin licensed dentists (n = 4,301) responded to the 2001 survey. A significantly higher likelihood of accepting new Medicaid patients was found for racial/ethnic minority dentists (35 versus 19 percent of White dentists) and dentists practicing in large practices (31 versus 16 percent for those in smaller practices). In the multivariable analysis, minority dentists [odds ratio (OR) = 2.06, 95 percent confidence interval (CI) = 1.30, 3.25] and dentists in practices with >3 dentists (OR= 2.25, 95 percent CI = 1.69, 3.00) had significantly greater odds of accepting new Medicaid patients. CONCLUSIONS: Racial/ethnic minority dentists are twice as likely as White dentists to accept new Medicaid patients. Dentists in larger practices also are significantly more likely than those in smaller practices to accept new Medicaid patients. These findings suggest that increasing dental workforce diversity to match the diversity of the general US population can potentially improve access to dental care for poor and minority Americans, and may serve as an important force in reducing disparities in dental care.