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Item Utilization of Silver Diamine Fluoride by Dentists in the United States: A Dental Claims Review(American Academy of Pediatric Dentistry, 2020) Scully, Allison; Yepes, Juan F.; Tang, Qing; Downey, Timothy; Maupome, GerardoPurpose: A Current Dental Terminology (CDT) code, D1354, for silver diamine fluoride was made effective on January 1, 2016. The purpose of this study was to investigate the utilization of silver diamine fluoride (SDF) by pediatric dentists (PDs) and general dentists (GDs) in the United States. Methods: Data were obtained from a commercial dental insurance claims warehouse in the United States. Deidentified data for CDT code D1354 were collected from January 2016 to July 2019. Descriptive statistics and chi-square tests were used. Results: A total of 321,726 D1354 claims were found. Data showed that SDF use measured by average monthly claims, unique number of dentists, and percent of paid claims increased each year. Patients zero to nine years old were the most likely to receive SDF treatment. SDF was significantly more likely to be placed on posterior teeth and in children zero to eight years old (P<0.001). PDs were more likely than GDs to submit claims for SDF in children (P<0.001). Conclusions: Silver diamine fluoride use is increasing, especially in patients age zero to nine years. Pediatric dentists are more likely to use SDF in children than general dentists. Posterior teeth receive the majority of SDF treatment.Item Prescription of Bitewing and Panoramic Radiographs in Pediatric Dental Patients: An Assessment of Current Trends and Provider Compliance(Journal of the American Dental Association, 2022-10) Menaker, Noah H.; Yepes, Juan F.; Vinson, LaQuia A.; Jones, James E.; Downey, Tim; Tang, Qing; Maupome, GerardoPurpose: To evaluate prescription patterns for bitewing and panoramic radiographs (PR) for pediatric and adolescent dental patients following the implementation of the most recent ADA/FDA guidelines. Methods: Paid insurance claims data for all 50 states were accessed from January 1, 2013 to June 30, 2019 for patients age 18 years and younger; a 5% random sample population was extracted. Statistical analyses were performed to evaluate various imaging metrics for pediatric dentists (PD) and general practitioners (GP). Results: A total of 2,123,735 bitewing images were prescribed during 4,734,249 office visits. The average time interval between bitewing exams ordered by GPs was 13.9 (± 7.4) months, and for PDs this average was 13.0 (± 6.7) months (p<.0001). When divided by age group, 3.5% of all bitewings were taken on patients age 0-4 years. For PRs, 286,824 images were included in the present study. The average time interval between PRs ordered for the same patient was 3.4 (± 1.3) years for PDs and 3.3 (± 1.4) years for GPs. One percent of all PRs were prescribed for patients age 0-4, with 403 images attributed to PDs and 2348 to GPs. Conclusions: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. Practical Implications: Inclusion of individual caries risk with insurance claims data should be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.Item Parental factors associated with routine dental visits in American children(2018) Yepes, Juan F.; Gibson, Joe; Nuñez-Castorena, Jessica; Eckert, George; Maupomé, GerardoBackground: Various factors have been associated with children with relatively low use of dental care. These include lower level of parents’ education, poor diet, smoking at home, lower household income, lack of dental insurance, living in a rural location, and cognitive impairment or disability. Goal: To further identify and characterize parental factors related with reduced use of routine dental visits in Indianapolis, Indiana, USA. Methods: Analyses of the 2012 Marion County Health Department survey were undertaken using multilevel logistic regression to assess the effect of individual and community variables on the probability of children’s use of routine dental visits. Results: Children from parents with a higher level of education, who did not smoke in the home, and families who ate fast food less often in the preceding 7 days, were more likely to have a routine dental visit in the prior 12 months. Conclusions: This study further delineates the complex associations between parental level factors and one important aspect of children’s oral health.Item Utilization of Stainless Steel Crowns by Pediatric and General Dentists(American Academy of Pediatric Dentistry, 2019) Shelton, Andrea; Yepes, Juan F.; Vinson, LaQuia A.; Jones, James E.; Tang, Qing; Eckert, George J.; Downey, Timothy; Maupome, GerardoPurpose: Dental caries affects 23% of US children aged two to five 1. Extensive caries in children should be treated with stainless steel crowns (SSC); however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of the study was to evaluate utilization of SSCs by pediatric and general dentists through insurance claims. Methods: Data was obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the U.S. A generalized linear mixed effects model tested differences in the utilization of SSCs by the general dentist versus the pediatric dentist. Results: The data included 107,487 general dentists and 5,395 pediatric dentists. The records included 2,555,726 claims for restorations and 440,423 claims for the SSC. Pediatric dentists are more likely to place SSCs compared to the general dentist. The tooth most often to receive a SSC was a primary second molar. The majority of SSCs were placed in children aged six years old. Conclusions: Pediatric dentists are more likely to restore carious primary dentition with SSCs compared to general dentists. Perhaps increasing training at the dental undergraduate level would increase the utilization of SSCs.Item Pathways to Culture, Health and Well-Being Understanding(Indiana University, 2022) Kalaitzi, Valia“Pathways to Culture, Health, and Well-Being Understanding” is a contemporary, open educational resource (OER) content created firsthand to serve the learning objectives of the "Culture, Health and Well-Being" course. This teaching book focuses on bringing together the new knowledge and developments on understanding how regional cultures and health are intertwined and influence our perceptions and choices on health and well-being. The aim is for students of all majors to get deeper insights on cultural competence as a key driver in the population’s health, health professions, and health systems as well as on its influence on health, and well-being across ethnic and vulnerable groupsItem Dentists Clinical Decision-Making for Erosive Tooth Wear: An Online Study(Elsevier, 2020) Goldfarb, Micah B.; Maupomé, Gerardo; Hirsh, Adam T.; Carvalho, Joana C.; Eckert, George J.; Hara, Anderson T.Objective: Erosive tooth wear (ETW) is an irreversible loss of dental hard tissue. This pilot study examined dentists’ ability to diagnose and manage ETW relative to sound and caries-affected teeth. Methods: Dentists recruited through the Indiana Dental Association (N=36) participated in an internet-based survey, containing twenty-two standardized images of buccal and occlusal surfaces of teeth (sound, ETW, or caries). For each image, they provided diagnosis (presence and differentiation) of dental condition, confidence in their judgment, management need, and likelihood to recommend specific management strategies. Dentists made these judgments for teeth with no, initial, moderate, or severe ETW/caries. Results: Dentists demonstrated poor detection of ETW compared to sound teeth and caries at each level of severity. The dentists were less confident, less able to correctly diagnose and manage ETW, and less likely to recommend most management strategies for ETW than caries at each level of severity. Conclusions: Dentists had difficulty correctly diagnosing (both detection and differentiation) and managing ETW, across all severity levels and particularly in early stages. These difficulties were particularly apparent when compared to caries. The current results are clinically relevant given the importance of early diagnosis for ETW management.Item Are dental patients able to perceive erosive tooth wear on anterior teeth? An internet-based survey assessing awareness and related action(Elsevier, 2020) Goldfarb, Micah B.; Hara, Anderson T.; Hirsh, Adam T.; Carvalho, Joana C.; Maupomé, GerardoBackground. Erosive tooth wear (ETW) is irreversible loss of dental hard tissue. The authors examined patients’ ability to recognize ETW relative to sound teeth and teeth with dental caries. Methods. Using Amazon’s crowdsourcing service, the authors recruited participants (N=623) to view standardized images of buccal surfaces of teeth (sound, ETW, or caries). Participants reported whether a dental condition existed (yes/no), likelihood to seek care, and esthetic attractiveness for teeth with no, initial, moderate, or severe signs of ETW/caries. Results. Dental patients demonstrated poor recognition of cases of ETW, especially compared to sound and caries-affected teeth at each level of severity. Patients were less likely to schedule a dental appointment for care/treatment of teeth with ETW than caries at each level of severity. Patients also found ETW more esthetically attractive than caries at each level of severity and found initial ETW more attractive than sound teeth. Conclusions. Dental patients struggle recognizing ETW, in general and compared to caries, at each level of severity and particularly for early stages of ETW. These recognition difficulties likely arise, in part, from tooth esthetic attractiveness standards (smooth and shiny teeth look more esthetic), possibly leading to lack of appropriate care-seeking behavior. Practical Implications. This internet-based tool may be used to assess dental patients’ awareness and ability to recognize cases of ETW. Improved patient awareness might lead to seeking professional care to prevent and/or delay ETW progression.Item Reflections on project ECHO: qualitative findings from five different ECHO programs(Taylor & Francis, 2021) Agley, Jon; Delong, Janet; Janota, Andrea; Carson, Anye; Roberts, Jeffrey; Maupomé, GerardoProject ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 as an innovative model to facilitate continuing education and professional development. ECHO emphasizes 'moving knowledge, not people.' To accomplish this, ECHO programs use virtual collaboration and case-based learning to allow practitioners, including those in rural and underserved areas, to receive specialist training. The ECHO model has expanded rapidly and is now used in 44 countries. Preliminary research on ECHO's efficacy and effectiveness has shown promising results, but evidence remains limited and appropriate research outcomes have not been clearly defined. To improve the evidence basis for ECHO, this study of 5 ECHO programs (cancer prevention/survivorship, integrated pain management, hepatitis C, HIV, and LGBTQ+ health care elucidated actionable insights about the ECHO programs and directions in which future evaluations and research might progress. This was a qualitative study following COREQ standards. A trained interviewer conducted 10 interviews and 5 focus groups with 25 unique, purposively sampled ECHO attendees (2 interviews and 1 focus group for each of the 5 programs). Data were transcribed verbatim and analyzed using the general inductive approach, then reviewed for reliability. We identified four major categories (reasons to join ECHO, value of participating in ECHO, ways to improve ECHO, and barriers to participation) composed of 23 primary codes. We suggest that thematic saturation was achieved, and a coherent narrative about ECHO emerged for discussion. Participants frequently indicated they received valuable learning experiences and thereby changed their practice; rigorous trials of learning and patient-level outcomes are warranted. This study also found support for the idea that the ECHO model should be studied for its role in convening communities of practice and reducing provider isolation as an outcome in itself. Additional implications, including for interprofessional education and model evolution, were also identified and discussed.Item Edentulism and other variables associated with self-reported health status in Mexican adults(International Scientific Information, Inc., 2014) Medina-Solís, Carlo Eduardo; Pontigo-Loyola, América Patricia; Pérez-Campos, Eduardo; Hernández-Cruz, Pedro; Avila-Burgos, Leticia; Mendoza-Rodríguez, Martha; Maupomé, GerardoBackground: To determine if edentulism, controlling for other known factors, is associated with subjective self-report health status (SRH) in Mexican adults. Material and methods: We examined the SRH of 13 966 individuals 35 years and older, using data from the National Survey of Performance Assessment, a cross-sectional study that is part of the technical collaboration between the Ministry of Health of Mexico and the World Health Organization, which used the survey instrument and sampling strategies developed by WHO for the World Health Survey. Sociodemographic, socioeconomic, medical, and behavioral variables were collected using questionnaires. Self-reported health was our dependent variable. Data on edentulism were available from 20 of the 32 Mexican states. A polynomial logistic regression model adjusted for complex sampling was generated. Results: In the SRH, 58.2% reported their health status as very good/good, 33.8% said they had a moderate health status, and 8.0% reported that their health was bad/very bad. The association between edentulism and SRH was modified by age and was significant only for bad/very bad SRH. Higher odds of reporting moderate health or poor/very poor health were found in women, people with lower socio-economic status and with physical disabilities, those who were not physically active, or those who were underweight or obese, those who had any chronic disease, and those who used alcohol. Conclusions: The association of edentulism with a self-report of a poor health status (poor/very poor) was higher in young people than in adults. The results suggest socioeconomic inequalities in SRH. Inequality was further confirmed among people who had a general health condition or a disability. Dentists and health care professionals need to recognize the effect of edentulism on quality of life among elders people.Item Treatment Needs for Dental Caries, Restorative Care Index, and Index of Extractions in Adolescents 12 and 15 Years Old(The University of the West Indies, 2013) Medina-Solís, CE; Pontigo-Loyola, AP; Mendoza-Rodríguez, M; Lucas-Rincón, SE; Márquez-Rodríguez, S; Navarrete-Hernandez, JJ; Maupomé, GerardoObjective: To determine the Treatment Needs Index (TNI) for dental caries, the restorative Care Index (CI), and to introduce a Tooth Extractions Index (TEI) to estimate past and current treatment needs among Mexican adolescents. Subjects and methods: A descriptive cross-sectional study was carried out on 1538 adolescents aged 12 and 15 years in the state of Hidalgo, Mexico, to collect decayed, missing, filled teeth (DMFT) data to describe TNI, CI and TEI indices. Results: Higher TNI was identified in younger male teenagers who had always lived in the same community, without dental visits in the last year, and who had poorer socio-economic markers. Higher CI was found in older, female subjects who had moved in their lifetimes to a new community in the area, with dental visits in the last year and who had better socio-economic markers. Higher TEI was found in older, female teenagers who had moved in their lifetimes to a new community in the area, without dental visits in the last year, and who had worse socio-economic markers. Conclusions: We observed high rates of treatment needs for dental caries and little experience of restorative treatment. While dental extractions due to advanced caries should ideally be zero, relatively few adolescents had this treatment experience. Despite the fact that the overall background of these adolescents is rather homogeneous, it was still possible to find that treatment needs' indices (past and present needs) appeared to be modified by sociodemographic and socio-economic variables.