An Interprofessional Education and Collaborative Practice Model for Dentistry and Pharmacy.

The aims of this study were to evaluate the feasibility of an interprofessional education and collaborative practice model (IECPM) developed by the School of Dentistry (SOD) and College of Pharmacy (COP) for the University of Minnesota dental clinics and to report results of the needs assessment using specific primary care metrics and medication histories gathered through use of the model in 2015-16. Planning focused on establishing a workflow to implement the IECPM by the SOD and COP. The interprofessional team that provided patient care for the study consisted of 50 dental students, ten dental therapy students, one pharmacy student, one pharmacy resident, one faculty pharmacist, one dental assistant, one faculty dental hygienist, and two dentists. The team selected 190 patients in the SOD clinic for the study based on the inclusion criteria: patients with two or more chronic medical conditions who were taking medications. The 190 patients received a comprehensive dental exam, review of social and medical history, and medication therapy management assessment by the interprofessional team. Specific core primary care metrics (blood pressure, pulse, tobacco use, and diabetes status) and identification of drug therapy problems (DTPs) were monitored and/or screened for during the dental visit. The results showed that the IECPM helped identify that this cohort of patients presented with chronic conditions: 64% had hypertension, 34% had diabetes, and 10.5% reported smoking cigarettes. Several DTPs were identified, of which "needs additional drug therapy" was the most common. This cohort was taking multiple medications (2-34 per patient) to address a variety of medical conditions. The study concluded that the IECPM with the SOD and COP helped address a primary care need that often goes unmet in dental clinics.

Trends in Generalist and Specialty Advanced Dental Education and Practice, 2005-06 to 2015-16 and Beyond.

This article reviews the data on advanced dental education for the past decade and explores what advanced dental education might look like in the years leading up to 2040, including how its graduates will address the oral health needs of the population. The authors based these projections on published data about advanced dental education collected by the American Dental Association and other organizations. Nevertheless, a certain degree of speculation was involved. The article presents current data and trends in advanced dental education, environmental factors impacting advanced dental education, and lessons drawn from other areas of health care that support the potential scenarios that are described. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Improving Documentation, Compliance, and Approvals in an Electronic Dental Record at a U.S. Dental School.

The aims of this study were to improve progress note documentation by dental students, achieve accurate and timely charge capture and treatment code and note approval, and determine the effectiveness of multiple interventions in improving overall documentation of patient encounters in the clinic of one U.S. dental school. The study, conducted in 2014-15, used a logic model to create a process to address documentation issues in the clinic's electronic dental record (EDR) and to assess the effectiveness of interventions. An initial documentation review using the EDR was performed to obtain a baseline measurement. A significant correlation was noted at baseline between poor documentation and unapproved treatment codes and notes. Unapproved treatment codes and corresponding documentation were then reviewed each month. Students who had the highest number of unapproved treatment codes were identified as potentially having documentation issues. These students were contacted and met individually with the associate quality and compliance officer to review documentation and charge practices. Large group education was also provided to key learners: dental students and supervising faculty members. Education consisted of an in-service event for faculty members and a Moodle site course on documentation for students. After one year, the results showed that documentation rates improved from an overall rate of 61% to 81% of required documentation elements being present in the progress note. Although this educational intervention was successful in significantly improving documentation of treatment in the EDR, 19% of the notes at the conclusion of the study were still missing key elements. Further research is necessary to determine whether the interventions will continue to improve documentation or if additional measures need to be taken.

Cost-effective analysis of topical chlorhexidine in hematologic patients at risk for oral mucositis.

OBJECTIVE: The aim of this study was to explore whether management of mucositis with Chlorhexidine (CHX) mouthwash could be a cost-effective method to decrease the risk of mortality and economic burden in hemato-oncologic or hematopoietic stem cell transplantation (HSCT) patients. METHODS: A cost-effectiveness analysis model of prophylactic CHX mouthwash use versus no-CHX mouthwash use for the prevention of oral mucositis was developed for patients undergoing cytotoxic therapy or HSCT. The outcome variable was survival. The primary variables were CHX mouthwash use, probability of mucositis, probability of increased hospital stay, and length of hospital stay. Probability and cost data were obtained from the literature. RESULTS: Our analysis selected CHX mouthwash use during anticancer treatment as the preferred strategy for the base-case analysis as compared to no CHX mouthwash (marginal value 0.032). There was a $14,391 cost difference per patient between the two strategies. CONCLUSION: The results of this study suggest that CHX mouthwash use during anticancer treatment results in an increased survival and decreased cost for the population studied. Using our base-case data, an additional 32 of every 1,000 hemato-oncologic or HSCT patients will survive when employing the preferred strategy of prophylactic CHX mouthwash. CLINICAL RELEVANCE: CHX mouthwash should be offered for hematologic patients undergoing HSCT or administered with chemotherapy.

Five-year prospective clinical evaluation of highly crystalline HA MP-1-coated dental implants.

Contemporary plasma-sprayed hydroxylapatite (HA) coatings with high crystalline content are much more resistant to in vivo degradation than HA coatings of a decade ago but reportedly exhibit reduced wettability, which could potentially negatively affect tissue adhesion and long-term clinical outcome. The present prospective study was undertaken to determine if highly crystalline HA MP-1-coated implants could meet a minimum 5-year implant success rate standard of 85% in view of their previously reported decreased wettability. Study subjects were consecutive patients with 1 or more missing teeth in the maxillary and/or mandibular jaw who presented in 3 university dental clinics and 1 private dental practice. A total of 120 patients were treated per protocol and successfully restored with implant-supported prostheses. Four implants failed in 3 patients and were withdrawn from the study. There were no other irresolvable adverse events. Cumulative implant success at 5 years was 97% (n = 184 implants in 88 patients), which exceeded the 85% standard for implant success after 5 years of clinical function.

Factors associated with oral health-related quality of life in community-dwelling elderly persons with disabilities.

OBJECTIVES: To examine, in community-dwelling elderly persons with disabilities, the association between oral health-related quality of life (OHRQOL) as measured using the 14-item Oral Health Impact Profile (OHIP-14) and specific oral health, health, and disability status variables; life satisfaction; living alone; and low income. DESIGN: Observational cross-sectional. SETTING: A Medicare demonstration conducted in 19 counties in three states. PARTICIPANTS: Six hundred forty-one disabled, cognitively intact, community-dwelling individuals aged 65 and older. MEASUREMENTS: The subjects' OHRQOL was assessed using the OHIP-14, which was scored using three different methods. Data on oral health, health and functional status, life satisfaction, prior health services use, and sociodemographics were collected using interviewer-administered questionnaires. RESULTS: The participants' mean age was 79.1, and they were dependent in an average of 1.8 activities of daily living (ADLs); 43.1% were edentulous, 77.4% wore a denture, 40.4% felt that they were currently in need of dental treatment, and 64.7% had not had a dental examination in the previous 6 months. Seven of the 16 variables of interest had significant bivariate relationships using three OHIP scoring methods. Logistic regression analysis found that poor OHRQOL was significantly associated with perceived need for dental treatment (odds ratio (OR)=2.61), poor self-rated health (OR=2.29), poor (OR=2.00) and fair (OR=1.73) mental health, fewer than 17 teeth (OR=1.74), and relatively poor cognitive functioning (OR=1.52). CONCLUSION: OHRQOL is associated with some (perceived need for dental treatment, poor self-rated health, worse mental health, fewer teeth, and relatively poor cognitive status) but not all (e.g., ADL and instrumental ADL dependence) measures of oral health, health, and disability status and not with life satisfaction, living alone, or low income.

A decision analysis: the dental management of patients prior to hematology cytotoxic therapy or hematopoietic stem cell transplantation.

There is a controversy regarding whether dental treatment before chemotherapy protocols, including hematopoietic stem cell transplantation (HSCT), is helpful to prevent infections during the consequent immunosuppression. The aim of this study was to develop a decision analysis framework that would test the effect of dental treatment prior to chemotherapy on the survival of the patient. A decision tree was created to compare the clinical outcomes of two treatment alternatives for a base-case patient receiving cytotoxics or undergoing HSCT. The variables used to build the model were "systemic infection", "unmet dental needs", "dental needs". The outcomes evaluate to compare the two strategies was "survival". We performed MEDLINE and PubMed searches of English-language literature according to a list of related terms. The decision analysis model selected dental treatment prior to chemotherapy as the preferred strategy for the base case analysis. The results of this study suggest that dental treatment prior to chemotherapy is the preferred treatment strategy. Using our base case data, 1.8 of every 1000 hemato-oncologic patients or HSCT patients will die compared to the non-treatment prior to chemotherapy strategy.

Preferences for oral health states in a US community-dwelling functionally impaired older adult population: 2000-2001.

OBJECTIVES: To determine whether and how much time in a state of ill oral health an older person would be willing to trade for optimal oral health. METHODS: This is a cross-sectional observational study of 76 subjects (52 female, 24 male) ages 47-93 (mean 75.2) recruited from a Medicare demonstration. Subjects had to need or receive help with 2+ activities of daily living (ADLs) or 3+ instrumental ADLs plus had to have had recent significant healthcare services use. A Time Trade-Off (TTO) approach was used. TTO utility is defined as the amount of symptom-free time (i.e., the optimal oral health state) divided by the amount of time with symptoms (either their current oral health state or the worst imaginable oral health state, depending on the scenario), at the point of indifference (the point past which the person is unwilling to trade additional life expectancy). RESULTS: When starting from their current oral health state, 39% of the subjects were willing to exchange time resulting in a shorter life with optimal oral health. They were willing to trade 14.0 months of life on average and valued each year in their current oral health state as 91% of a year in optimal oral health. When starting in the poorest oral health state, 79% of the subjects were willing to accept a shorter life. They were willing to trade 33.7 months of life on average, and valued the poorest state as worth 79% of a year in optimal oral health. CONCLUSIONS: Dentists should take into consideration this group's preference for optimal oral health.

Education of dentists in the treatment of patients with special needs.

The dental education system has been suggested as the vital link in providing a workforce capable of improving oral health for people with special needs. Dental education institutions not only train dental professionals for their role in providing oral health services for people with special needs, they also provide a significant amount of services to this population in their clinical environments. However, there is no consensus about whether to concentrate the educational efforts on the preor postdoctoral level, or both. Furthermore, it is not clear if educational initiatives in the care of patients with special needs will translate into a larger oral health workforce willing to treat these patients. However, for the purposes of this paper, it will be assumed that more education and training in special care dentistry will lead to better-educated dentists and the desired result of better access to care for special needs patients. The authors will define special needs patients as those who have a chronic physical, developmental, behavioral, or emotional condition, and who also require health and related services of a type or amount beyond that the general population requires. This paper will describe accreditation issues and discuss the advantages and disadvantages of special care education in pre- and postdoctoral training and beyond.