Perceived social status, socioeconomic status, and preventive dental utilization among a low-income Medicaid adult population.

OBJECTIVES: Perceived Social Status (PSS) is a measure of cumulative socioeconomic circumstances that takes perceived self-control into account. It is hypothesized to better capture social class compared to socioeconomic status (SES) measures (i.e., education, occupation, and income). This study examined the association between PSS and dental utilization, comparing the strength of associations between dental utilization and PSS and SES measures among a low-income adult Medicaid population. METHODS: A cross-sectional survey was administered to a random sample of low-income adults in Iowa, United States with Medicaid dental insurance (N = 18,000) in the spring of 2018. Respondents were asked about PSS, dental utilization, and demographics. A set of multivariable logistic regression models examined the relative effects of PSS and SES measures on dental utilization, controlling for age, sex, health literacy, whether the respondent was aware they had dental insurance, transportation, and perceived need of dental care. RESULTS: The adjusted response rate was 25%, with a final sample size of 2252. Mean PSS (range 1-10) was 5.3 (SD 1.9). PSS was significantly associated with dental utilization (OR = 1.11; CI = 1.05, 1.18) when adjusting for control variables, whereas other SES measures-education, employment, and income-were not. CONCLUSIONS: PSS demonstrated a small positive association with dental utilization. Results support the relative importance of PSS, in addition to SES measures, as PSS may capture aspects of social class that SES measures do not. Results suggest the need for future research to consider the effects of PSS on oral health outcomes and behaviors.

Introducing dental students to dental public health: An analysis of US predoctoral course syllabi.

Dental public health competencies in predoctoral dental education ensure that students have the skills to succeed in an increasingly complex professional environment. This study examined existing public health curricula in US dental education and their alignment with national recommendations from the American Association of Public Health Dentistry (AAPHD) and guidance from the Healthy People Curriculum Task Force for health professions education programs. We contacted all US dental schools (N = 66) in November 2020-January 202 and requested syllabi for schools' first course with dental public health content. We received 34 syllabi, which provided textual data for content analysis. The authors used an initial content analysis tool to extract descriptive course characteristics. Then, direct and emergent coding was performed to summarize course content. Direct codes included the 23 dental public health topics specified by AAPHD recommendations. Uncategorized content was coded using an inductive approach to identify emergent course themes. Frequently covered topics included principles of dental public health (79% of syllabi) and access to care (79%). "Health disparities" was the most common emergent theme, with 50% of courses including related content. There was little consistency in how courses approached each topic. For example, the topic "access to care" covered healthcare delivery systems, determinants of health, legislative reform, and advocacy. Dental public health was often taught alongside unrelated content. Recommendations for dental public health competencies should be updated to include new educational priorities, align with current national recommendations, and align with Commission on Dental Accreditation Standards more clearly.

Who provides open-ended comments? Assessing item nonresponse bias in Medicaid surveys of members and dentists.

OBJECTIVES: This aim of this study was to examine factors associated with survey item nonresponse to open-ended items in mailed surveys. METHODS: Data sources include two surveys conducted in Iowa in 2016 - one to a random sample of Medicaid dental program members and one to private practice dentists. Item nonresponse bias for open-ended comments was examined by comparing differences between commenters and noncommenters. Bivariate and logistic regression analyses examined differences based on demographic characteristics, attitudes, and experiences with the program, and survey mode. RESULTS: Among members, respondents who were Black, older, unemployed, had a recent dental visit, rated the plan poorly, and completed the survey on paper were significantly more likely to provide comment. Among dentists, those who participated in the plan and those who completed the survey online were significantly more likely to provide comment. CONCLUSIONS: Members and dentists with direct experiences with the Medicaid dental program were more likely to provide open-ended survey comments, whereas we found inconsistent results between members and dentists with regard to the impact of demographic characteristics, survey mode, and attitude toward the plan.

Member and dentist narratives about a dental programme for the Medicaid expansion population: A content analysis.

OBJECTIVES: In the United States, the 2010 Affordable Care Act's Medicaid expansion improved financial access to dental care for new Medicaid enrollees in states with Medicaid dental benefits for adults. Using an existing theoretical framework, we explored dentist and Medicaid member narratives concerning a state's redesigned dental programme for the Medicaid expansion population. METHODS: Data sources include two surveys conducted in 2016-one to a random sample of Medicaid members and one to private practice dentists in Iowa. A qualitative content analysis approach was used to quantify and describe themes present in open-ended comment data. RESULTS: The most common themes among Medicaid member narratives were related to oral health needs and status, availability of dentists who accept Medicaid, and Medicaid coverage for dental care. Among dentists, the programme's administrative burden was the most common theme, with coverage and reimbursement commonly cited as well. An emergent theme among both member and dentist comments was patient confusion or lack of knowledge about programme enrolment and coverage. CONCLUSIONS: Member awareness about enrolment and coverage in public dental benefit plans should be further explored to determine the impact on access to care. Effectively communicating the intent, programme design and expectations of a Medicaid programme to both providers and Medicaid members is important to the success of the programme.

Periodontal treatment needs in the Medicaid patient population: a retrospective study in a US dental school.

OBJECTIVES: The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively investigate associations between periodontal treatment needs and insurance type in a newly insured adult Medicaid population. We hypothesized that newly insured Medicaid patients, covered by the Iowa Dental Wellness Plan (DWP), would display greater need for treatment than patients with other sources of financing. METHODS: A retrospective chart review of EHRs of patients at the University of Iowa College of Dentistry and Dental Clinics (UI COD) from 2014 to 2016 was completed. The outcome of interest whether or not a new patient was indicated for scaling and root planing (SRP) based on clinical examination. Logistic regression models analyzed associations between treatment need and source of financing, adjusting for known periodontal disease risk indicators. RESULTS: A total of 1,259 patient charts were evaluated. SRP was indicated for 56 percent of all patients. Patients with DWP coverage had significantly greater unadjusted odds of being indicated for SRP than privately insured individuals (OR = 1.47, P = 0.009). However, this association did not remain significant after adjusting for known risk indicators. CONCLUSIONS: Although individuals enrolled in DWP were not significantly more likely to need treatment than individuals with other sources of financing when adjusting for risk indicators, their demonstrated clinical need was higher than privately insured adults. Public benefit programs could anticipate greater burden of periodontal need in low-income populations due to increased prevalence of risk factors in this population.

Evaluation of enrollee satisfaction with Iowa's Dental Wellness Plan for the Medicaid expansion population.

BACKGROUND: Dental coverage for Iowa's Medicaid expansion population is provided through the Dental Wellness Plan (DWP), implemented in May 2014. The plan targets healthy behavior incentives via an earned benefits structure, whereby additional services are covered if enrollees return every 6-12 months for routine dental visits. This study examines enrollee satisfaction with the DWP. METHODS: We surveyed a random sample of DWP enrollees 1 year after program implementation about their experiences. Survey items covered dental plan satisfaction, self-rated measures of health, and knowledge and attitudes toward the earned benefits approach. RESULTS: Dental plan satisfaction was rated as low by 38 percent of respondents (n = 416), moderate by 25 percent (n = 276), and high by 37 percent (n = 402). A majority of respondents (66 percent) did not know about the earned benefits structure. Regression analysis indicated that respondents most likely to have low plan satisfaction were those who felt it was difficult to earn benefits (OR 3.66, P < 0.001) and those who were unable to find (OR 3.17, P < 0.001), or did not try to find (OR 3.51, P < 0.001), a regular dentist in the plan. CONCLUSIONS: Satisfaction with a new model of dental insurance was influenced by whether enrollees had a regular source of care and their perceived ability to return for regular checkups in order to earn covered benefits.