Faculty Bibliography

The SARS-CoV-2 pandemic created societal upheaval well beyond what anyone, but the oldest of Americans, has seen in their lifetime. As the pandemic begins to subside, it is leaving behind a legacy of permanently changed practices, including enhanced environmental controls in clinical settings, reconsideration of modes of personal protective equipment outsourcing, changes and/or reinterpretation of dental practice acts, and entirely new approaches to testing and vaccine design, among many others. This article focuses on one change that the authors hope will prevail: greater trust in the dental profession as a valuable public resource during healthcare crises. The article cites the initial low perception of dentistry as an important component of a health surge response by public health authorities, then describes how a group of eight institutions came together to form the "Testing for Tomorrow Collaborative" to help each other and the dental profession identify modes of testing and practice conduct that make dentistry safer to practice. The importance of the public's trust in the profession is underscored, and pathways to improving that trust are proffered.

Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.

BACKGROUND AND OVERVIEW: A meeting to explore ways to expand access to oral health care for seniors-possibly by expanding a dental benefit in Medicare-was convened in Arlington, VA, by the Santa Fe Group. Four factors motivated the meeting: PRACTICAL IMPLICATIONS: The model Medicare dental benefit presented generated much discussion. There was agreement that any dental benefit must attract participating dentists. Agreement was also reached on the importance of public demonstration projects to further establish cost savings from dental care for patients with comorbid diseases, the need to collaborate with nondental advocacy and policy groups to establish that overall health benefits for seniors are gained by adding oral health care, and the necessity of oral health literacy campaigns working directly at the community level with the general public and others, including educators and the media, as well as with policy makers and providers from all health fields and at all levels of professional training.

We appreciate that Stadtlander views dental practices as having the potential to serve as important alternate sites for identifying systemic health disorders, a potential that we argued is especially critical for the many millions of adults and children in the United States who visit a dentist but not a general health provider in a given year. Toward this end, Stadtlander encourages the development and use of detailed health questionnaires before the dental visit to identify or exclude risk factors for systemic disease. We agree that this would be useful; research has demonstrated the value of using dental patients' health information to identify those at high risk for diabetes.(1-3) We also agree with Stadtlander that the collection of vital signs would be helpful. We would add to this the value of collecting saliva or blood samples to screen for infectious or chronic disease. Targeted dental provider education regarding the value and importance of this screening to both patients and providers would likely increase providers' use of patients' health histories, vital signs, and biological samples for this purpose, as would demonstration of its feasibility and acceptability in busy dental practices. In fact, research has demonstrated dental providers' and dental patients' appreciation for chronic disease screening at dental visits.(4-6) (Am J Public Health. Published online ahead of print July 19, 2012: e1. doi:10.2105/AJPH.2012.300866).

We appreciate the response to our article regarding the proportion and characteristics of patients who saw a dentist but not a primary care health provider in 2008. Like Greenberg and Glick, we also performed an earlier analysis using National Health and Nutrition Examination Survey (NHANES) data. We determined the proportion of individuals at increased risk of having diabetes, but who were unaware of that increased risk.(1) We found that 93% of US persons over 20 years of age, undiagnosed with diabetes but with moderate or severe periodontal disease, have risk factors indicating the importance of diabetes screening. We determined that 50% of those persons had seen a dentist in the past year and could have been screened for diabetes in the dental office. We appreciate Greenberg and Glick's analysis regarding the potential use of the dental visit to identify males at increased risk for developing a severe cardiovascular event.(2) Like their subsequent analyses demonstrating dental provider and patient willingness to participate in patient screening for medical conditions in the dental office,(3,4) our research has shown the willingness of dentists and patients to be screened for diabetes.(5) This is especially the case if screening involves the use of oral blood from at-risk patients with periodontal disease. (Am J Public Health. Published online ahead of print May 17, 2012: e1. doi:10.2105/AJPH.2012.300742).

We assessed the proportion and characteristics of patients who do not regularly visit general health care providers but do visit dentists and whose unaddressed systemic health conditions could therefore be identified by their dentist. Of the 26.0% of children and 24.1% of adults that did not access general outpatient health care in 2008, 34.7% and 23.1%, respectively, visited a dentist. They varied by census region, family income, and sociodemographics. Dental practices can serve as alternate sites of opportunity to identify health concerns among diverse groups of US patients.

The health care delivery system is poised for substantial change in the coming years. The foremost vector driving this change is economics. However, use of evidence-based principles of practice and a high desire, if not a national mandate, for increased quality in health care delivery are also very important factors. Nestled within this large national health care debate are a set of issues that directly impact dental education and practice. Among them is the potential impact of expanded intraprofessional and interprofessional collaborations among dentists, dental therapists, dental hygienists, and nurse practitioners, among others, in search of better oral and general health care for all Americans. This article explores many of the issues involved in this possible transition with special reference to the impact of the changes on dental education.