Change in parental knowledge and beliefs about early childhood dental caries following a pragmatic community-based trial.

OBJECTIVES: To evaluate parent knowledge and belief changes following the MySmileBuddy (MSB) early childhood caries (ECC) intervention. METHODS: Pre- and post-intervention surveys were completed by 669 parents of children with visually-evident ECC from among 977 participants in a 6-12-month pragmatic community-based caries management trial administered by community health workers (CHWs). Six domains of knowledge about caries and motivating and facilitating determinants were assessed via 26 survey items. Principal components analysis and reliability testing reduced dataset dimensionality. Parent and CHW characteristics were analyzed as potential moderators. Paired T-tests measured pre-to-post-intervention changes. Generalized estimating equations accounted for within-participant correlation with significance set at p < 0.05. RESULTS: Twenty items consolidated into five factors (saliva, hygiene, diet, seriousness/susceptibility, and outcome expectations). Six additional items were evaluated individually. Positive post-intervention changes (p < 0.0001) were observed across all factors and all but one individual item (tooth decay is very common). Greatest knowledge increases related to caries as a bacterial disease in two measures, the saliva factor and a single caries belief item tooth decay is an infectious disease (0.59 unit increase, 95% CI [0.55, 0.64] and 0.46 unit increase, 95% CI [0.4, 0.51], respectively), and in the value of fluoridated water over bottled (0.46 unit increase, 95% CI [0.39-0.53]). Most parents improved knowledge of ECC salivary (72%) and dietary risks (57%), and preventative hygiene behaviors (59%). CONCLUSIONS: MSB enhanced knowledge and beliefs about caries and confirmed hypothesized mediators of behavior change among parents of high-risk children. Engaging peer-like CHW interventionists may have moderated intervention effects, warranting further exploration.

A scoping review of the economic impact of family oral health: Implications for public health, research, and policy.

OBJECTIVES: To summarize evidence on the impact of oral health on individual and family economic outcomes, describe trends in the literature, and identify areas for additional research to inform public health research and practice. METHODS: Searches were conducted within PubMed, CINAHL, EconLit, Cochrane Library, PsycInfo, and Web of Science databases. Article review, selection, abstraction, and reporting processes were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: Of 2758 unduplicated records identified, 52 met inclusion criteria. Study outcomes included indicators of employment/employability (n = 9), earnings/earnings potential (n = 26), parent missed work and family financial impacts of child oral health (n = 19), and financial loss (n = 3). Dental caries-related variables were the most common predictors of poorer economic outcomes. Other oral health problems, such as poorer dental functioning or poorer self-reported oral health status, also were associated with adverse economic outcomes. Significant associations with employment were found among studies that assessed interventions designed to improve oral health. Only one study estimated the impact of oral health on earnings. One-third of studies conducted multivariable analyses, and 14% incorporated race and ethnicity variables. CONCLUSIONS: Although existing evidence suggests associations between oral health problems and poorer economic outcomes, there is a substantial need for more rigorous research to better understand the extent of economic impact of oral health problems and which populations are most affected. Additional high-quality research is needed to inform which interventions are most likely to improve oral health, reduce adverse economic impacts, and promote health and economic equity.

U.S. Government Accountability Office Reports on Children's Oral Health and Dental Care: A 31-Year Retrospective Analysis.

Purpose: The purpose of this study was to identify and analyze reports and testimonies from the U.S. Government Accountability Office (GAO) relevant to children's oral health and dental care during the calendar years 1990 through 2021. Methods: The GAO database was searched for reports and testimonies that directly or tangentially addressed children's oral health and dental care. Titles, abstracts, and texts were reviewed to determine what Congress asked of GAO and how GAO responded. Results: Among nearly 30,000 health- and health care-related GAO releases over 31 years, 35 were focused on children's oral health and/or dental care. In response to requests by key congressional committees and legislators, reports addressed coverage, access, utilization, cost, network adequacy, workforce, and safety net. Multiple reports addressed the persistence of health and health care inequities. GAO's findings have supported dental mandates for the Children's Health Insurance Program (CHIP) and Affordable Care Act, the federal pediatric Oral Health Initiative, and congressional oversight of federal agencies that administer Medicaid/CHIP and train dentists. Conclusions: Over more than a quarter century, the U. S. Government Accountability Office has contributed meaningfully to congressional understanding of pediatric oral health and dental care. Continued reliance by Congress on GAO investigations can further enhance policy-making and oversight on issues important to pediatric dentistry.

State Medicaid Authorities' Policy Communications With Providers on Individualized Pediatric Dental Care.

OBJECTIVES: Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) pediatric benefit is designed to meet children's medically necessary needs for care. A 2018 Centers for Medicare & Medicaid Services (CMS) Bulletin advised Medicaid programs to ensure that their dental payment policies and periodicity schedules include language that highlights that medically necessary care should be provided even if that care exceeds typical service frequency or intensity. We assessed the extent to which Medicaid agencies' administrative documents reflect EPSDT's flexibility requirement. METHODS: From August 2018 through July 2019, we retrieved dental provider manuals, periodicity schedules, and fee schedules in all 50 states and the District of Columbia; analyzed these administrative documents for consistency with the CMS advisory; and determined whether instructions were provided on how to bill for services that exceed customary frequencies or intensities. RESULTS: Dental-specific periodicity schedules were not evident in 11 states. Eighteen states did not include flexibility language, for example, as advocated by the American Academy of Pediatric Dentistry. Flexibility language was not evident in 24 dental provider manuals or in 47 fee schedules. Only 8 states provided billing instructions within fee schedules for more frequent or intensive services. CONCLUSION: Updating Medicaid agency administrative documents-including dental provider manuals and periodicity and fee schedules-holds promise to promote individualized dental care as ensured by EPSDT.

Analysis of YouTube videos related to a child's first dental visit.

BACKGROUND: As parents increasingly turn to online videos for paediatric dental information, it is important to assess the content of those videos and determine whether parents are receiving accurate information. AIM: To describe and assess the video characteristics, viewer engagement, and content of the most-viewed YouTube videos about a child's first dental visit. DESIGN: The 100 most popular YouTube videos related to a child's first dental visit were assessed for consistency with current professional guidelines, which included a first visit by age 1, tooth cleaning or prophylaxis, fluoride application, caries risk assessment, dietary counseling, oral hygiene instruction, frequency of dental visits, and anticipatory guidance. Differences in video characteristics (length, age, and viewer engagement) were assessed using the Kruskal-Wallis test and the post hoc Mann-Whitney U test, and differences in content and characteristics by video upload source (healthcare professionals, parents/caregivers, and independent media outlets) were examined using the chi-square test and the Fisher's exact test. RESULTS: The predominant upload source was parents/caregivers (40%) followed by independent media outlets (32%) and healthcare professionals (28%). Median video length was 2 min, 24 s (IQR = 2:05-3:49), and median video age was 4 years (IQR = 3-4 years). Most videos were filmed in a paediatric dental office (73%) and focused on motivational vs. educational content (77% vs. 23%, respectively). With regard to viewer engagement, videos uploaded by media outlets generated higher viewing rates than those uploaded by parents/caregivers (mean rank [MR] = 44.7 vs. 24.8, respectively) and healthcare professionals (MR = 34.8 vs. 31.5) and higher interaction rates than those uploaded by parents/caregivers (MR = 50.8 vs. 25.0) and healthcare professionals (MR = 39.1 vs. 20.6). Videos uploaded by healthcare professionals were more likely to provide educational content consistent with professional recommendations, particularly regarding caries risk assessment (32.1%), dietary counseling (21.4%), and frequency of dental visits (10.7%), than videos uploaded by parents/caregivers (5.0%, 5.0%, and 0%, respectively) and media outlets (0%, 3.1%, and 0%, respectively). CONCLUSIONS: This study found that the most popular videos related to a child' first dental visit, as measured by viewer engagement, were uploaded by parents or caregivers, were longer and newer, and featured motivational rather than educational content. The 100 most-viewed videos rarely presented information that was consistent with professional recommendations for children's oral health, particularly regarding caries risk assessment and anticipatory guidance.

Analysis of 100 Most-Viewed YouTube Toothbrushing Videos.

Purpose: Parental education regarding the importance of toothbrushing and how to brush children's teeth is a key factor influencing pediatric oral health and You Tube videos have become a popular source of health information. The purpose of this study was to examine the descriptive features of the 100 most frequently viewed English-language YouTube toothbrushing videos and evaluate their usefulness relative to professional guidelines.Methods: A structured YouTube web search identified the 100 most frequently viewed toothbrushing videos during a six-month period (10/1/17 - 4/30/18). Two independent evaluators assessed each video for consistency with professional recommendations using a priori criteria. Each video was also assessed for descriptive characteristics, user engagement, and content. Comparative analyses by video source (health care professionals, commercial, and independent media) were performed, and an exploratory regression model was used to test the relationship between video characteristics and usefulness for parent education.Results: The top 100 YouTube videos were most often posted by independent media outlets (78%), targeted toward children (70%), and less than 2 minutes long (56%). Few videos aligned with professional recommendations regarding toothbrushing frequency (38%), toothbrushing duration (24%), amount of toothpaste (21%), fluoride toothpaste use (19%), post-brushing behavior (10%), toothbrush selection (4%), and toothbrush replacement (3%). A stepwise bidirectional regression model found that videos posted by health care professionals were significantly more likely to contain recommendations consistent with professional recommendations compared with other upload sources.Conclusion: The most frequently viewed toothbrushing videos were not uploaded to the Internet by health care professionals. Videos uploaded by health care professionals contained significantly higher counts of professional recommendations however, they differed in audio and visual format and production style compared to those from commercial and independent media sources.

Protocol for a family-centered behavioral intervention to reduce early childhood caries: the MySmileBuddy program efficacy trial.

BACKGROUND: Although largely preventable through diet management and topical fluoride use, early childhood caries (ECC) often progresses to severity that necessitates surgical repair. Yet repair often fails to mitigate caries progression. Needed is an effective behavioral intervention to address underlying behavioral causes. METHODS: This randomized controlled trial will evaluate the efficacy of a behaviorally focused, family-centered intervention, the MySmileBuddy Program (MSB Program), to reduce ECC progression in high-risk preschoolers in New York City. Recruitment will target 858 children ages 24-71 months with ECC and their parents from primary care medical and dental clinics. The study aims to assess the MSB Program's efficacy to: (1) decrease ECC progression measured 12-months post-randomization; and (2) enhance adoption of a low cariogenic diet and twice-daily fluoridated toothpaste use compared to control group. Potential causal pathways (mediators and moderators) will be explored. The MSB Program equips community health workers (CHWs) with an app that facilitates multilevel risk assessment and provides motivational interviewing-based counseling to inform parents about the caries process, develop personalized goals, and create family-level action plans to achieve targeted behaviors. Social support from CHWs (4 interactions during the 6-month intervention, supplemented by up to 4 in-person/remote contacts throughout the 12-month study period, based on need) is bolstered by automated text messages. Participants will be randomized to a Control Group (paper-based educational handout plus toothbrushes and fluoridated toothpaste for the child) or Intervention Group (MSB Program, two tooth-brushing observations with feedback and instruction, and toothbrushes and toothpaste for the entire family). All children will receive visual ICDAS dental examinations and parents will complete study measures at baseline and 12-months. An incentive up to $150 plus round-trip transit cards ($5.50 value) will be provided. DISCUSSION: This study hypothesizes that the MSB Program can reduce ECC progression in a high-risk population. Sufficient incentives and a focus on establishing rapport between participants and CHWs are anticipated to mitigate recruitment and retention challenges. If successful, this study will advance the long-term goal of reducing pediatric oral health disparities by demonstrating the efficacy of an acceptable and feasible intervention that shifts attention from dental repair to behavioral risk mitigation. TRIAL REGISTRATION: Trial registration was completed on 4/13/2021 through the U.S. National Library of Medicine ClinicalTrials.gov website (Identifier: NCT04845594).

Small-area socioeconomic status and children's oral health in a safety-net care delivery setting.

OBJECTIVES: To better understand the impact of small-area socioeconomic status (SES) on caries experience and sealant presence among children receiving services through a comprehensive community-based safety-net oral health program. METHODS: Census-tract level household data from the American Community Survey was utilized to construct an index that reflects the small-area socioeconomic environments in which children receive oral health services. This area SES index was entered into a logistic model with sociodemographic participant data collected by the community-based oral health program to consider its association with outcomes (caries and sealant experience) at first program visit, among children older and younger than 5 years. RESULTS: Among poor children older than 5 years of age, higher census-tract level SES was associated with lesser caries experience and greater sealant experience at presentation for care to a community-based oral health program. Each standard deviation increase in census-tract level SES index was associated with reduced odds of any caries experience (aOR = 0.92; 95 percent CI 0.85, 0.99; P = 0.021) and increased odds of sealants (aOR = 1.20; 95 percent CI 1.05, 1.37; P = 0.009). Among children 5 years and under, only grade was associated with both outcomes. CONCLUSIONS: Within an inner city area of poverty, the greater a census tract's socioeconomic risks to health, the greater the odds that children over age five experience caries and the lesser their odds of having dental sealants. While associations between SES and oral health outcomes across the full spectrum of SES have been recognized, this study suggests that within lower SES areas, SES-associated gradients exist in children's oral health.

Medicaid Dental Provider Enrollment Processes: National Assessment and Policy Recommendations.

Purpose: This study assessed state Medicaid dentist enrollment processes and identified best practices for state authorities. Methods: A 2018 search of state government websites identified entities involved in enrolling and credentialing dentists. States were classified according to their administrative approach. Results: Twenty-two states administered their dental programs internally, 24 through contracted Medicaid managed care organizations (MMCOs), and five through a combined approach. Thirteen of 22 (59 percent) internally-administered and eight of 24 (33 percent) MMCO-administered states carved out their dental programs to a dental managed care organization. Twenty-one of 22 (95 percent) state-administered but only nine of 24 (38 percent) MMCO-administered programs provided complete enrollment instructions. To serve the entire pediatric Medicaid population in a given state, dentists needed to enroll and be credentialed by one to eight entities. Providers needed to complete an average of one application and one contract in carved-out and internally administered states, three applications and two contracts in dental MCO carved-out states, and five applications and four contracts in MMCO states. Conclusions: Medicaid enrollment complexity varies considerably across states and is highly influenced by managed care. Recommendations to enhance the enrollment process include dentist-specific guidance, online and automated enrollment platforms, streamlined applications, and application consolidation.

Children's dental service use reflects their parents' dental service experience and insurance.

BACKGROUND: Decisions about children's oral health care are made by parents. Parents' dental insurance, dental service use, and perceived affordability all influence their children's oral health care. METHODS: Using data from the 2016 National Health Interview Survey, the authors constructed a database of 4,396 nationally representative US children and their linked household adults. The authors assessed the relationship between children's and parents' use of dental services, private and public dental insurance, and deferral of oral health care owing to cost. To adjust for factors that may influence outcomes independently, the authors performed multivariate analyses to consider child, parent, and household characteristics. RESULTS: Children have 2 times the risk of lacking a dental visit in a year if the parent has none, 7 times the risk of reportedly lacking dental coverage if the parent has none, and nearly 10 times the risk of having care deferred owing to cost if the parent finds oral health care unaffordable. Affordability risk factors for children include older age and minority race, whereas protective factors include public insurance, parents with higher educational attainment, and female-led households. Increased oral health care use by children was associated with states that provide more extensive adult Medicaid dental benefits. CONCLUSIONS: Greater parental dental service use, dental coverage, and ability to afford care benefit their children's use of oral health care. PRACTICE IMPLICATIONS: Policies by employers and government that expand quality private and public coverage for adults hold strong promise to improve oral health care for both parents and their children.

Outcomes from the Health Resources and Services Administration's Dental Faculty Development Program.

PURPOSE/OBJECTIVES: While the Commission on Dental Accreditation (CODA) requires programs to conduct faculty development, implementation of faculty development activities vary widely. Faculty development programs can enhance teaching, research, and leadership skills needed to transition from clinical practice to teaching. In 2012, the Health Resources and Services Administration (HRSA) funded 6 institutions to plan, develop, and operate programs for training oral healthcare providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene. This performance study examines the results of the dental faculty development programs. METHODS: After the 5-year grant program (2012-2017), we used descriptive analysis to examine annual performance data including trainee demographics, faculty development activities, post-completion intentions, and course development activities. RESULTS: Nearly 300 trainees participated across 6 funded grantees; the majority were female, aged 30-49 years, and non-Hispanic White. For those who completed, 80% intended to teach. Common faculty development activities included community-based training, curriculum enhancements, Web-based training, and interprofessional education methods. Faculty development modalities included faculty seminars, Master's degrees, and mentoring. Pipeline activities, online resources, and continuing education supported dental students and providers moving into academics. CONCLUSIONS: Faculty development better prepares individuals to compete in academic environments and develop faculty. Community-based programs may utilize faculty development to recruit community preceptors and achieve calibration. HRSA investment in faculty development programs builds resources and infrastructure to promote continuing engagement in clinical education, research, and administrative skills. Future research is needed to establish the impact of faculty development initiatives on practice change and patient outcomes.

Non-clinical Experiences Influence Dental Students' Career Plans to Care for the Underserved.

Equitable dental care across U.S. populations remains a national concern. Previously reported predictors of dental student altruism include student and school characteristics. This study additionally considered the effect of educational experiences on dental students' anticipation of providing care to medically underserved populations, areas, or facilities at some point during their careers. Data from 2014-2017 graduating student surveys (response rate 62%) assessed the relationship between students' intention to provide care to the underserved and student sociodemographic, clinical, non-clinical, faculty-interaction, research, and organizational experience during dental education. Respondents were 52% female and 18% underrepresented minorities. Positive intention ranged from 51% for "working in a practice that accepts Medicaid" to 25% for "practicing in an underserved rural community" with 45% intending to "work in a community health clinic." Higher levels of intention were significantly correlated with student diversity, maturity, and involvement with non-clinical faculty and activities.

Feasibility, Acceptability, and Short-term Behavioral Impact of the MySmileBuddy Intervention for Early Childhood Caries.

OBJECTIVES: To evaluate acceptability, feasibility, and short-term behavioral impact of an early childhood caries (ECC) intervention. METHODS: Predominantly low-income Hispanic parent/child (2-6 years) dyads attending a busy pediatric dental clinic in New York City completed a single administration of the iPad-based technology-assisted education, goal-setting, and behavior change MySmileBuddy program. Self-reported behavior change was assessed via telephone survey one month post-intervention. RESULTS: Of 113 parent/child dyads approached, 108 (95.6%) participated and all completed MySmileBuddy in its entirety. Over 96% (n = 76) of 79 parents reached for follow-up recalled MySmileBuddy; 63.3% (n = 50) recalled their diet-and/or oral hygiene-related behavioral goal; and 79.7% (n = 79) reported taking action to initiate behavior change. CONCLUSIONS: Findings suggest that MySmileBuddy was feasibly implemented in a busy clinic, acceptable to this high-risk population, and effectively promoted preliminary ECC-related behavior changes. Larger, long-term studies are warranted to further investigate the impact of the MySmileBuddy program.