Publications

2021
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
Elani H, Kawachi I, Sommers B. Medicaid healthy behavior incentives and use of dental services. Health Services Research. 2021. Publisher's Version
Jiang T, Ticku S, Alamer N, Alhazmi H, Harvan R, Riedy C. Context matters: Integration of social determinants of health in AEGD and GPR curricula. Journal of Dental Education. 2021. Publisher's Version
Mosen D, Banegas M, Dickerson J, Fellows J, Brooks N, Pihlstrom D, Kershah H, Scott J, Keast E. Examining the association of medical-dentalintegration with closure of medical care gapsamong the elderly population. The Journal of the American Dental Association. 2021;152 (4) :302-308. Publisher's Version
Riordain RN, Glick M, Mashhadani SSAA, Aravamudhan K, Barrow J, Cole D, Crall J, Gallagher J, Gibson J, Hegde S, et al. Developing a standard set of patient‐centred outcomes for adult oral health – an international, cross‐disciplinary consensus. International Dental Journal. 2021;71 (1) :40-52. Publisher's Version
Choi SE, Simon L, Riedy C, Barrow J. Modeling the Impact of COVID-19 on Dental Insurance Coverage and Utilization. Journal of Dental Research. 2021;100 (1) :50-57. Publisher's Version
Choi SE, Choudhary A, Sonis S, Villa A. Benefits of the Involvement of Dentists in Managing Oral Complications Among Patients With Oral Cavity and Oropharyngeal Cancer: An Analysis of Claims Data. JCO Oncology Practice. 2021. Publisher's VersionAbstract
PMID: 33555929
Glick M, Williams D, Yahya IB, Bondioni E, Cheung W, Clark P, Jagait C, Mathur MR, Listl S, Mossey P, et al. Vision 2030: Delivering Optimal Oral Health for All. Geneva: FDI World Dental Federation. 2021. Publisher's Version
Ahern J, Singer S, Bhanja A, Barrow J, Kerrissey M. Considering Dentists Within the Healthcare Team: a Cross-sectional, Multi-State Analysis of Primary Care Provider and Staff Perspectives. Journal of General Internal Medicine. 2021. Publisher's Version
2020
Improving Access to Dental Care for Pregnant Women through Education, Integration of Health Services, Insurance Coverage, an Appropriate Dental Workforce, and Research. American Public Health Association . 2020. Publisher's Version
Choi SE, Wright D, Bleich S. Impact of Restricting Sugar-Sweetened Beverages From the Supplemental Nutrition Assistance Program on Children's Health. American Journal of Preventive Medicine. 2020. Publisher's Version
Birch S, Ahern S, Brocklehurst P, Chikte U, Gallagher J, Listl S, Lalloo R, O'Malley L, Rigby J, Tickle M, et al. Planning the Oral Health Workforce: Time for Innovation . Community Dentistry and Oral Epidemiology . 2020;00 :1-6. Publisher's VersionAbstract

PMID: 33325124

Benzian H, Beltrán-Aguilar E, Mathur MR, Niederman R. Pandemic Considerations on Essential Oral Health Care. Journal of Dental Research. 2020. Publisher's VersionAbstract
The coronavirus disease 2019 (COVID-19) pandemic revealed a lack of consensus on the concept of essential oral health care. We propose a definition of essential oral health care that includes urgent and basic oral health care to initiate a broader debate and stakeholder alignment. We argue that oral health care must be part of essential health care provided by any health system. Essential oral health care covers the most prevalent oral health problems through an agreed-on set of safe, quality, and cost-effective interventions at the individual and community level to promote and protect oral health, as well as prevent and treat common oral diseases, including appropriate rehabilitative services, thereby maintaining health, productivity, and quality of life. By default, essential oral health care does not include the full spectrum of possible interventions that contemporary dentistry can provide. On the basis of this definition, we conceptualize a layered model of essential oral health care that integrates urgent and basic oral health care, as well as advanced/specialist oral health care. Finally, we present 3 key reflections on the essentiality of oral health care. First, oral health care must be an integral component of a health care system’s essential services, and by implication, oral health care personnel are part of the essential health care workforce. Second, not all dental care is essential oral health care, and not all essential care is also urgent, particularly under the specific risk conditions of the pandemic. Third, there is a need for criteria, evidence, and consensus-building processes to define which dental interventions are to be included in which category of essential oral health care. All stakeholders, including the research, academic, and clinical communities, as well as professional organizations and civil society, need to tackle this aspect in a concerted effort. Such consensus will be crucial for dentistry in view of the Sustainable Development Goal’s push for universal health coverage, which must cover essential oral health care.
Haber J, Hartnett E, Allen K, Crowe R, Roitman J, Feldman L, Fletcher J, Ng G. Attaining interprofessional competencies by connecting oral health to overall health. Journal of Dental Education. 2020. Publisher's VersionAbstract
PURPOSE:The purpose of this study was to evaluate the effectiveness of an annual oral-systemic health interprofessional education (IPE) clinical simulation and case study experience with nurse practitioner/midwifery (NP/MW), dental (DDS), medical (MD), and pharmacy (PharmD) students. METHODS:The Interprofessional Collaborative Competency Attainment Scale (ICCAS) was used to measure students' self-reported attainment of interprofessional competencies before and after the IPE experience. Pre- and post-test surveys were completed by NP/MW, DDS, MD, and PharmD student cohorts from 2017 to 2019. Students also had the opportunity to provide qualitative feedback about their experience at post-test. Data were collected from IPE faculty facilitators to assess their perception of the value of the Teaching Oral-Systemic Health (TOSH) program. RESULTS:Student ICCAS results demonstrated statistically significant improvement in self-reported interprofessional competencies among all types of students across all 3 years (P < 0.001); qualitative student comments reflected positive experiences with the TOSH program. Survey data from IPE faculty facilitators supported the value of the IPE experience for all students. CONCLUSIONS:The findings demonstrate the effectiveness of the TOSH program in using oral-systemic health as a clinical exemplar to develop interprofessional competencies. The 2017-2019 data reinforce the credibility of scaling the TOSH model for developing interprofessional competencies with students from different health professions.
Barrow J, Silk H, Phillips R, Riedy C. Oral Health is Health: The Future is Now. Journal of Health Care for the Poor and Underserved, Johns Hopkins University Press. 2020;31 (4) :99-103. Publisher's Version
Ticku S, Savageau J, Harvan R, Silk H, Isong I, Glicken A, Dolce M, Riedy C. Primary Care and Oral Health Integration: Comparing Training Across Disciplines. Journal of Health Care for the Poor and Underserved, Johns Hopkins University Press. 2020;31 (4) :344-359. Publisher's Version

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