# Publications

2022
Alpert E, Lisa Simon MD DMD, Barrow J. A Call To Measure The Oral Disease Burden In Nursing Homes. Health Affairs. 2022. Publisher's Version
Donoff RB, Simon L. To achieve oral health in America, dental education needs to evolve. The Journal of the American Dental Association. 2022;153 (8) :731-733. Publisher's Version
Choi SE, Mo E, Palmer N, Fox K, Da Silva JD, Nagai S, Barrow JR. Cognitive impairment and edentulism among older adults: an observational study using claims data. 2022;22 (1) :278. Publisher's VersionAbstract
The scientific link between mastication strength and cognitive function has not yet been strongly corroborated in population studies. Utilizing large-scale claims, we aim to investigate the association between edentulism and cognitive impairment in older American adults.
Beck N, Choi SE, Barrow J. The Need for High-Quality Economic Evaluations in Dentistry. International Dental Journal. 2022. Publisher's Version
Chandel T, Alulaiyan M, Farraj M, Riedy CA, Barrow JR, Brennan L, Thompson L, Bass MB, Chamut S. Training and educational programs that support geriatric dental care in rural settings: A scoping review. Journal of Dental EducationJournal of Dental EducationJ. Dent. Educ. 2022;n/a (n/a). Publisher's VersionAbstract
Abstract Purpose/Objectives Access to dental care for older adults is challenging, especially for those living in rural areas. People living in rural areas are less likely to visit the dentist, have greater oral health needs, and face significant oral health disparities. Given the projected increase in the older adult population, the aim of this study was to conduct a scoping review (SR) to identify the current landscape of geriatric dental training in rural healthcare settings. Methods Four guiding concepts (i.e., dental workforce, education/training, rural setting, and older adult population) were searched in PubMed, Embase (Elsevier), Dental and Oral Sciences Source (EBSCO), and ERIC (EBSCO) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EndNote and Covidence were used for de-duplication algorithms and title/abstract screening. Results Seventy-nine citations were identified for the final full-text review based on inclusion and exclusion criteria, and ten articles were eligible for data extraction as applicable to the research question. Three themes emerged from the review: geriatric dentistry inclusion within dental school curricula, clinical training at rural/remote locations, and improving geriatric oral health knowledge through interprofessional training. Conclusion This SR highlights the limited number of currently trained geriatric dentists, as well as, the paucity of dental programs/curricula offered to produce competent dental geriatricians with an advanced skill set for practicing in rural settings. Our review indicates the need to expand the dental workforce, curricula, and training to better position dentists to serve the older and underserved population in rural and remote areas.
Bahdila D, Ticku S, Nath S, Aflatooni N, Dolce MC, Hackley DM, Barrow JR. Pandemic preparedness in dental education: A US-based national survey. Journal of Dental EducationJournal of Dental EducationJ. Dent. Educ. 2022;n/a (n/a). Publisher's VersionAbstract
Abstract Objectives The Coronavirus Disease-19 (COVID-19) pandemic highlighted the need for pandemic preparedness (PP) in health professions training. We aimed to (1) establish a current profile on curricular content of PP in US dental schools and (2) examine how schools were adapting their curricula in response to COVID-19. Methods An online survey was developed and sent to senior leadership to all 66 Commission on Dental Accreditation (CODA)-accredited US dental schools including Deans of Academic or Clinical Affairs from November 2020?February 2021. Questions addressed PP curricular content, teaching methods, and evaluation. Participants were asked about the barriers and facilitators for the inclusion of this content. The survey also included questions on redeployment of the clinical workforce in response to the pandemic. Results The response rate was 31.8% (n = 21) with representation from every US Census Bureau-designated division. While all responding dental schools agreed that dental professionals can play an important role during pandemics, 38.1% reported including content on PP into their pre- or postdoctoral curriculum. In response to the COVID-19 pandemic, approximately 47.6% indicated redeployment of their clinical workforce to participate in disaster life support, assisting physicians in COVID-19 cases, and assisting hospitals with personal protective equipment (PPE). Conclusion There was general agreement that dental professionals can play an important role during pandemics. The participating US dental schools responded to the COVID-19 pandemic by integrating novel clinical activities. More efforts are required to include PP in dental education.
Walji MF, Spallek H, Kookal KK, Barrow J, Magnuson B, Tiwari T, Oyoyo U, Brandt M, Howe BJ, Anderson GC, et al. BigMouth: development and maintenance of a successful dental data repository. J Am Med Inform Assoc. 2022 :ocac001. Publisher's VersionAbstract
Few clinical datasets exist in dentistry to conduct secondary research. Hence, a novel dental data repository called BigMouth was developed, which has grown to include 11 academic institutions contributing Electronic Health Record data on over 4.5 million patients. The primary purpose for BigMouth is to serve as a high-quality resource for rapidly conducting oral health-related research. BigMouth allows for assessing the oral health status of a diverse US patient population; provides rationale and evidence for new oral health care delivery modes; and embraces the specific oral health research education mission. A data governance framework that encouraged data sharing while controlling contributed data was initially developed. This transformed over time into a mature framework, including a fee schedule for data requests and allowing access to researchers from noncontributing institutions. Adoption of BigMouth helps to foster new collaborations between clinical, epidemiological, statistical, and informatics experts and provides an additional venue for professional development.
Brock M, Bahammam S, Sima C. The Relationships Among Periodontitis, Pneumonia and COVID-19. Frontiers in Oral Health. 2022;2. Publisher's VersionAbstract
Periodontitis is a chronic inflammatory disease of the supporting structures of the teeth that affects approximately half of adults 30 years and older. There is increasing interest in the direct and indirect relationships between periodontitis and systemic diseases, including respiratory diseases. The aim of this study was to assess the evidence on links among periodontitis, pneumonia, and COVID-19. Oral and periodontal bacteria may be linked to respiratory disease directly by aspiration of pathogens into the lungs causing pneumonia. As SARS-CoV-2 began to spread worldwide in 2020, questions have arisen of how periodontal disease may also be connected to SARS-CoV-2 infection and severity, including potential replication and dissemination of the virus from periodontal pockets. Some proposed mechanisms include the oral cavity acting as a reservoir or point of entry for SARS-CoV-2, overgrowth of periodontal pathogens, and increased production of proinflammatory cytokines. Due to potential links between periodontal disease and respiratory infections like pneumonia and SARS-CoV-2, oral hygiene and management of periodontitis remain essential to help reduce infection and transmission of SARS-CoV-2.
Choi SE, Choudhary A, Huang J, Sonis S, Giuliano AR, Villa A. Increasing HPV vaccination coverage to prevent oropharyngeal cancer: A cost-effectiveness analysis. 2022;13 :200234. Publisher's VersionAbstract
The incidence of oropharyngeal cancer (OPC) has been rising, especially among middle-aged men. While Human Papillomavirus (HPV) has been irrevocably implicated in the pathogenesis of oropharyngeal cancer (OPC), the current HPV vaccination uptake rate remains low in the US. The aim of our study was to evaluate the impact of increased HPV vaccination coverage on HPV-associated OPC incidence and costs. A decision analytic model was constructed for hypothetical cohorts of 9-year-old boys and girls. Two strategies were compared: 1) Maintaining the current vaccination uptake rates; 2) Increasing HPV vaccination uptake rates to the Healthy People 2030 target (80%) for both sexes. Increasing HPV vaccination coverage rates to 80% would be expected to prevent 5,339 OPC cases at a cost of $0.57 billion USD. Increased HPV vaccination coverage would result in 7,430 quality-adjusted life year (QALY) gains in the overall population, and it is estimated to be cost-effective for males with an incremental cost-effectiveness ratio of$86,940 per QALY gained under certain conditions. Expanding HPV vaccination rates would likely provide a cost-effective way to reduce the OPC incidence, particularly among males.
2021
Simon L, Choudhary A, Ticku S, Barrow J, Tobey M. Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross-sectional study of a state all-payer claims database. Journal of Public Health DentistryJournal of Public Health DentistryJ Public Health Dent. 2021;n/a (n/a). Publisher's VersionAbstract
Abstract Background Individuals with opioid use disorder (OUD) are at higher risk of poor oral health. Medication for opioid use disorder (MOUD) has been shown to improve outcomes for patients with OUD, but it is unknown how initiation of MOUD affects access to oral health services. Methods This was a retrospective analysis of all individuals in the Massachusetts All-Payer Claims Database prescribed oral buprenorphine-naloxone or injectable naltrexone from 2013 to 2016. We evaluated dental utilization in the year before and after beginning MOUD. A logistic regression predicting dental utilization was conducted. Results Among the 54,791 individuals, rates of dental utilization were low both before and after MOUD (10.5% and 10% with a dental visit, respectively). Of those who did not have a dental visit in the year before starting MOUD, 95.1% did not have a dental visit in the year after. Rates of various procedure types were comparable before and after MOUD. In a logistic regression, a prior dental visit was associated with 9.82 times the odds (95% CI 9.14?10.55) of having a dental visit after starting MOUD; increasing age, being prescribed naltrexone, having a mood disorder or HIV, year of initiation or being on Medicaid were also associated with having a dental visit. Male patients and those with Medicare or private insurance were less likely to have a dental visit. Conclusions Initiating MOUD did not substantially result in increased dental access or substantial changes in dental procedures received. Patients receiving treatment for OUD may require additional support to access dental care.
Scrivani SJ, Keith DA, Kulich RJ, DaSilva AF, Donoff BR, Handa S, Holland N, Lerman MA, McCauley JL, Reisner L, et al. Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond. Journal of pain research. 2021;14 :1371 - 1387. Publisher's VersionAbstract
Over the past year our attention has inevitably been on the coronavirus pandemic, the health and welfare of our families, patients, and office staffs as well as the re-opening of our dental practices. In addition, the opioid crisis continues, is very likely to worsen as a result of the pandemic and continues to be a challenge to Dentistry. National public health issues and healthcare disparities continue and have created a global concern for providing evidence-based, adequate pain management in the dental setting. We have brought together a group of national thought leaders and experts in this field who will share their insights on the current state of opioid prescribing in Dentistry and describe some of the exciting work being done in advancing pain management. The learning objectives for this conference proceedings were: Describing the implications of current public health concerns for safe and effective pain management in dental medicine.Identifying risk factors and understanding the current guidelines for the use of opioid and non-opioid medications in dental medicine.Analyzing the interprofessional collaborations necessary for effective pain management in dental medicine.Recognizing the challenges and opportunities brought about by the COVID-19 pandemic for the dental profession.Applying evidence-based strategies for managing the complex pain patient in the dental setting.Appraising new and future modalities for the assessment and management of orofacial pain.
Jivraj A, Barrow J, Listl S. VALUE-BASED ORAL HEALTH CARE: IMPLEMENTATION LESSONS FROM FOUR CASE STUDIES. Journal of Evidence Based Dental Practice. 2021 :101662. Publisher's VersionAbstract
Value-Based Healthcare has gained considerable attention in medicine but relatively little in oral health care so far. Implementation of Value-Based Oral Health Care (VBOHC) is complicated by a multitude of system-level and contextual factors, especially the siloed innovation culture in dentistry which has been evolving separately from the broader medical system. Previous literature has described 4 key limitations to adaptation of value-based health care, that is creating multidisciplinary units, measuring patient-centered outcomes, attributing and communicating costs, and bundling payments. This paper presents 4 case studies on oral health care which provide relevant learnings about addressing challenges when seeking to implement VBOHC: (i) The Nurse Practitioner-Dental (NPD) Model outlines an approach for creating a multi-disciplinary center in monitoring chronic diseases improving healthcare outcomes; (ii) Treatment of Early Childhood Caries displays the utility of quality measures in value measurement and placing patients at the center of their care; (iii) ClearChoice Dental Implant Centers outlines how cost attribution leads to better management and creation of value centers; and (iv) Proposed Payment Model Changes in Oral Maxillofacial Surgery outlines a method to cover all episodic care of this otherwise expensive disease. Despite the challenges of implementing VBOHC, this paper provides insights into its feasibility and actionability.
AlDukhail S, Alhazmi H, Riedy C, Barrow JR, Chamut S. Oral health outcomes among adults with diabetes served at HRSA-funded health centers. Journal of Diabetes and its Complications. 2021;35 (9) :107979. Publisher's VersionAbstract
Objectives To examine the association of diabetes with tooth loss and oral manifestations among adult health center patients (HCPs). Methods This cross-sectional study utilized the nationally representative 2014 HCPs-Survey. Descriptive and logistic regression analyses limited to adults (n = 5524) were used to compare self-reported responses of tooth loss and oral manifestations (i.e., loose teeth, bleeding gums, mouth sores, and dry mouth) among HCPs with and without diabetes. Results Almost a quarter of the HCPs reported having diabetes. Among patients with diabetes, more than half were 45–64 years old, had low-income status, and attended rural health centers. Analyses revealed that diabetes was significantly associated with permanent tooth loss and presence of at least one oral manifestation after controlling for confounders. Among adults with diabetes, probability of “missing at least one tooth.” were two times higher compared to not missing any teeth [AOR = 2.10, (95%CI 1.40–3.16); P ≤0.001]. Adults with diabetes had higher odds of having one or more “oral manifestations” compared to adults without diabetes [AOR = 1.60, (95%CI 1.22–2.11); P = 0.001]. Conclusion Diabetes disproportionately affects HCP adults (23%) compared to the general U.S. adult population (10%). In HCPs having diabetes was associated with a higher prevalence of oral manifestations (i.e., loose teeth, bleeding gums) and losing “At least one” of their permanent teeth. These findings suggest that adults with diabetes had higher prevalence of oral manifestations and tooth loss, highlighting the need for innovative interprofessional models for early screening and identification.
Chamut S, Boroumand S, Iafolla TJ, Adesanya M, Fazio EM, Dye BA. Self-Reported Dental Visits Among Older Adults Receiving Home- and Community-Based Services. Journal of Applied Gerontology. 2021;40 (8) :902-913. Publisher's VersionAbstract
Objective: To investigate factors associated with infrequent dental use among older adults receiving home- and community-based services. Method: This cross-sectional study analyzed responses from the 2014 National Survey of Older Americans Act participants who received home- and community-based services. Descriptive and multivariable analyses were conducted to examine the association between infrequent dental use and key sociodemographic and health indicators. Results: Infrequent dental use was highest among adults participating in case management and home-delivered meals (63%); the lowest among those participating in congregate meals (41%). Participants who did not complete high school were 2 to 5 times more likely to be infrequent dental users compared to those with educational attainment beyond high school. Discussion: Among older adults receiving home- and community-based services, improving oral health knowledge and health literacy may reduce infrequent dental use.
Simon L, Giannobile WV. Is It Finally Time for a Medicare Dental Benefit?. New England Journal of MedicineNew England Journal of Medicine. 2021. Publisher's Version
Choi SE, Simon L, Basu S, Barrow JR. Changes in Dental Utilization Patterns due to COVID-19 among Insured Patients in the US. The Journal of the American Dental Association. 2021. Publisher's VersionAbstract
Background Demand for dental services has been known to be closely linked to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to the coronavirus disease 2019 (COVID-19) thus may have a significant impact on dental utilization. Methods Using de-identified dental practice management data in 2019 and 2020, we observed variations in dental utilization among insured patients since the COVID-19 outbreak (during the period of practice closure and after reopening) by patient age, procedure types, insurance type, practice size, geographic area, and reopening status. We examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models. Results While dental utilization among privately insured individuals fully rebounded by August 2020, utilization still remained lower than the pre-pandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased up to 60 times during practice closure. Geographic characteristics–such as median household income, percentages of rural or African American populations, and dental professional shortage designations –were significantly associated with the number of procedures performed at dental practices. Conclusion As a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particular among patients covered by public insurance or residing in underserved areas. Practical Implications: During these economic downturns, state health officials would be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or mid-level dental providers in underserved areas.
Elani HW, Kawachi I, Sommers BD. Dental Outcomes After Medicaid Insurance Coverage Expansion Under the Affordable Care Act. JAMA Network Open. 2021;4 (9) :e2124144-e2124144. Publisher's VersionAbstract
Dental coverage for adults is a state option in Medicaid, and despite significant gains in coverage after the Medicaid expansion under the Affordable Care Act (ACA), dental outcomes among adults in expansion states remain unexplored.To explore the association of state coverage of dental benefits through Medicaid expansion with clinical dental outcomes.This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey from 2009 to 2018. Included participants were low-income adults aged 19 to 64 years with income up to 138% of the federal poverty level. The study used a difference-in-differences analysis to compare changes from before to after ACA expansion in expansion states vs in control states. Changes were examined in the full sample and separately in states that did and did not provide Medicaid adult dental benefits. We defined a state as providing Medicaid adult dental benefits if it covered services beyond emergency dental benefits in 2014. Data were analyzed from November 2020 to March 2021.Medicaid expansion under the ACA.Rates of health coverage, having a dental visit, affordability of dental care in the past year, poor oral health, and teeth flossing were obtained from self-reported data. Mean number of missing teeth and prevalence of untreated decayed teeth, filled teeth, and functional dentition were obtained from clinical examination data.Among 7637 low-income adults, the mean (SD) age was 37.8 (13.4) years and 4153 (weighted percentage, 54.5 %) were women. At baseline, 1732 low-income adults in nonexpansion states compared with 2520 low-income adults in expansion states were more likely, as shown by weighted percentage, to be Black (473 individuals [21.0%] vs 508 individuals [15.1%]) and US born (1281 individuals [76.7%] vs 1613 individuals [69.6%]). In the full sample, Medicaid expansion, compared with nonexpansion, was associated with an increased rate of seeing a dentist in the prior year (12.4 percentage points; 95% CI 4.6 to 20.2 percentage points; P = .003). In expansion states that provided dental benefits, compared with nonexpansion states that provided dental benefits, the expansion was associated with increases in rates of Medicaid coverage (8.2 percentage points; 95%CI 0.5 to 15.8 percentage points; P = .04) and having seen a dentist in the previous year (11.4 percentage points, 95% CI, 3.7 to 19.1 percentage points; P = .006) and decreases in the uninsured rate (−12.6 percentage points, 95% CI −18.9 to −6.4 percentage points; P < .001) and prevalence of untreated decayed teeth (−16.8 percentage points; 95% CI, −25.5 to −8.0 percentage points; P = .001). In states without Medicaid dental benefits, the expansion was associated with an increase in the mean number of missing teeth (1.3 teeth; 95% CI 0.1 to 2.5 percentage points; P = .04) and a decrease in the prevalence of functional dentition (−8.7 percentage points; 95% CI, −14.1 to −3.3 percentage points; P = .003) compared with nonexpansion states.This study found that the combination of Medicaid expansion and coverage of Medicaid dental benefits was associated with improved oral health among low-income adults.
Choi SE, Kalenderian E, Normand S-L. Measuring the quality of dental care among privately insured children in the United States. Health Services Research. 2021. Publisher's Version
Ticku S, Barrow J, Fuccillo R, McDonough J. Oral Health Stakeholders: A Time for Alignment and Action. Milbank Quarterly . 2021. Publisher's Version
Choi SE, Choudhary A, Ahern J, Palmer N, Barrow JR. Association between maternal periodontal disease and adverse pregnancy outcomes: an analysis of claims data. Family Practice. 2021. Publisher's Version