Variation in General Dentists' Patterns of Sealant Use in Children with Elevated Caries Risk.

Introduction: Strong evidence supports use of dental sealants to prevent tooth decay, and professional guidelines recommend use in children with elevated caries risk. However, not all children indicated for sealants receive this preventive intervention, even when they use routine dental care.

Objective: The aim of this study was to explore the extent to which dentists' use of sealants varied in pediatric patients with elevated caries risk.

Predictors of Multiple Jobholding among Dental Hygienists in the State of Iowa.

Little is known about the prevalence of multiple jobholding practices among dental hygienists or the factors contributing to these employment patterns. The purpose of this exploratory study was to examine predictors of multiple jobholding practices among dental hygienists in the state of Iowa. A mailed paper survey was sent to all licensed dental hygienists (n=2080) in Iowa in May 2018.

A tale of two public dental benefit programs: Iowa dentist participation in traditional Medicaid versus a Medicaid expansion program.

Background: In Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population. The programs differed with respect to reimbursement, administration, and benefit structure. This study explored differences in patterns and predictors of dentist participation in the two programs.

The patient-centered dental home: A standardized definition for quality assessment, improvement, and integration.

Objective: To develop the first standardized definition of the patient-centered dental home (PCDH).

Data Sources/study Setting: Primary data from a 55-member national expert panel and public comments.

Study Design: We used a modified Delphi process with three rounds of surveys to collect panelists' ratings of PCDH characteristics and open-ended comments.

Relationship between community-level variables and number of general dentists.

Background: In this study, the authors used observational data from 2014 to evaluate the association between the number of general dentists and several community characteristics.

Methods: The authors collected community-level characteristics from secondary sources for all 947 Iowa incorporated communities to study their relationships with the mean number of general dentists per 1,000 population per square mile (population density), the dependent variable. The authors used zero-inflated negative binomial models to examine the association between the dependent and predictor variables.

Transportation Barriers and Use of Dental Services among Medicaid-Insured Adults.

This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa's Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen's behavioral model of health services use.

The Effects of Medical Well Baby Visits in Promoting Earlier First Dental Visits for Children.

The objective of the study was to assess the effects of medical well baby visits in promoting earlier first dental visits. We analyzed Iowa Medicaid claims data (2000-2013). The sample included 4 cohorts of children born in 2000, 2003, 2007, or 2010 and enrolled in Medicaid from birth ( = 38,211).

The Effects of Distance to Dentists and Dentist Supply on Children's Use of Dental Care.

Objective: To examine the effects of distance to dentists and dentist supply on dental services use among children with Medicaid coverage in Iowa.

Data Source: Iowa Medicaid claims for enrolled children between 2000 and 2009.

Study Design: The study sample included 41,554 children (providing 158,942 child-year observations) who were born in Iowa between 2000 and 2006 and enrolled from birth in the Iowa Medicaid program.

An Interactive Website to Facilitate In-State Retention of New Dentists and Recruitment to Underserved Areas.

Some U.S. states have more difficulty than others in recruiting or retaining dentists.

Public Dental Safety Net in Iowa: Capacity and Readiness for Health Care Reform.

Objective: Examine the current capacity of Iowa's public dental safety net and organizational readiness for implementation of the Affordable Care Act (ACA).

Methods: We surveyed Iowa Community Health Center (CHC) dental clinics for factors related to clinic capacity and organizational readiness for ACA-related change.

Results: With 14 clinics (93%) responding, clinics had means of 13,064 patient visits and 23% broken appointments in 2012.

Dental Visits by Age One: General Dentist Availability for Privately Insured Children in a Rural State.

Purpose: To evaluate the availability of general dentists who treat very young children with private insurance in the context of recommendations for age one dental visit.

Methods: Administrative data from Delta Dental of Iowa were analyzed to identify general dentists providing care to children younger than 18 years old in 2005 and 2012. Characteristics of dentists providing care to children younger than two years old were compared, examining changes over time.

Travel burden and dentist bypass among dentally insured children.

Objectives: Using administrative data from Iowa Medicaid and a large private dental insurer, we compared distance to the nearest primary care dentist for children ages 6-15 in 2012. Additionally, we examined rates of provider bypass in both populations as an indicator of spatial accessibility to dental care.

Methods: We calculated measures of travel burden, including distance to the nearest primary care dentist and distance to current primary care dentist.

Predicting dentists' decisions: a choice-based conjoint analysis of Medicaid participation.

Objectives: Private practice dentists are the major source of care for the dental safety net; however, the proportion of dentists who participate in state Medicaid programs is low, often due to poor perceptions of the program's administration and patient population. Using a discrete choice experiment and a series of hypothetical scenarios, this study evaluated trade-offs dentists make when deciding to accept Medicaid patients.

Methods: An online choice-based conjoint survey was sent to 272 general dentists in Iowa.

Dental care after an emergency department visit for dental problems among adults enrolled in Medicaid.

Background: Dental emergency department (ED) visits are increasing nationally, but EDs provide only palliative care. The authors examine time to subsequent dentist visit within 6 months after the ED visit, as well as the effect of having a dentist visit in the prior year.

Methods: Using 2010-2012 Iowa Medicaid claims data, the authors identified adults with an index dental ED visit.

Parental perceptions of avoidability of their child's emergency department visit.

Objectives: To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.

Design: Cross-sectional study by performing secondary analysis of 2010-2011 Iowa Child and Family Household Health Survey data.

Setting: State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.

Geographic variation of dental utilization among low income children.

Spatial accessibility of dental care is mediated by dentist workforce availability and travel costs. In this study, we generated dental service areas through small area analysis of Medicaid administrative data and claims. Service areas were then used to assess dimensions of spatial accessibility, including dentist-to-population ratios, and examine relationships in geographic variation of routine dental care among Medicaid-enrolled children.

Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs.

Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11.

The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits.

Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid.

The relationship between altruistic attitudes and dentists' Medicaid participation.

Background: The authors investigated the role of private practitioners in the dental safety net, including the provision of care for Medicaid enrollees and attitudinal factors that affect participation.

Methods: In 2013, the authors sent a mixed-mode survey to all general dentists in Iowa assessing their current Medicaid participation and factors affecting participation, including attitudinal statements about altruism, the Medicaid program, and the government's role in providing access to dental care.

Results: Fifty-six percent of responding dentists accepted new Medicaid-enrolled patients; dentists living in nonmetropolitan areas were significantly more likely to accept Medicaid than were those in metropolitan areas.

Career influences among final year dental students who plan to enter private practice.

Background: Existing research about the influence of educational debt on students' decision to enter general practice immediately after graduation is conflicting. Other potential factors that could affect this decision include the influence of a spouse or other family member, the importance of a mentoring dentist, and how students perceive the burden of their debt. The goal of this study was to examine the importance of debt on career decision-making while also considering the role of other influences.

Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study.

Objectives: The study assessed the time until first dental caries for young children seen at five Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject.

Methods: Forty children were randomly selected at each FQHC (n = 200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6.

Association between dentists' participation in charitable care and community-based dental education.

The Institute of Medicine and the Commission on Dental Accreditation (CODA) have recommended that dental schools incorporate community-based dental education (CBDE) programs into their curricula. The expectation is that CBDE participation will help dental students gain the skills and motivation to treat vulnerable populations after graduation. The purpose of this study was to determine whether dentists' involvement with charitable dental care is associated with participation in CBDE as dental students.

An explanatory model of factors related to well baby visits by age three years for Medicaid-enrolled infants: a retrospective cohort study.

Background: Well baby visits (WBVs) are a cornerstone of early childhood health, but few studies have examined the correlates of WBVs for socioeconomically vulnerable infants. The study objective was to identify factors related to the number of WBVs received by Medicaid-enrolled infants in the first three years of life and to present a preliminary explanatory model.

Methods: We analyzed Iowa Medicaid claims files and birth certificate data for infants born in calendar year 2000 (N = 6,085).

General dentist characteristics associated with rural practice location.

Purpose: To examine whether there is a difference in the likelihood that a general dentist practices in a rural location based on individual characteristics, including dental school attended, birth state, practice arrangement, sex, and age.

Methods: All private practice, general dentists in Iowa were included in this study. Data were extracted from the year 2010 version of the Iowa Dentist Tracking System, which monitors practice patterns of active dentists.