Dental Public Health and Education Commons^™

Understanding The Relationship Between Children's Oral Health Utilization And Parent's Use Of Healthcare Services, Shillpa Naavaal, Rashmi Lamsal

Dental Public Health and Policy Publications

Introduction: Parents play an influential role in their children's lives, but little is known about how their healthcare experiences connect. This study examined the relationship between parent's healthcare use and their child's overall and preventive dental care use.

Methods: We pooled three years (2017–2019) of Medical Expenditure Panel Survey (MEPS) data and merged child (0–17 years) and parent data. Our outcomes included any dental visit, preventive visit, and receipt of sealant or fluoride. The primary exposure variable was the parents’ medical and dental care use, grouped into four categories. Descriptive and bivariate analyses were conducted, and multivariable logistic regression analyses …

Investigating The Association Between Parental Paid Sick Leave Benefit And Children's Dental Care Utilization, Rashmi Lamsal, Shillpa Naavaal

Dental Public Health and Policy Publications

Objective: The purpose of this research is to examine the association between paid sick leave (PSL) benefit for employed parents and their child's dental care utilization, including preventive, diagnostic, and treatment services.

Methods: Using pooled data from the 2017–2019 Medical Expenditure Panel Survey, we created a dyadic observational unit linking children aged 0–17 years with their parents (n = 7652) specifically focusing on the younger children of employed parents. Descriptive statistics and a multivariate logistic regression model were employed to examine the association between parental PSL benefit and child dental care utilization, accounting for various child and …

Oral Health Impact And Cost-Effectiveness Of Resealing First Permanent Molars, Christina Scherrer, Pritam Deb, Jayden Ayash, Shillpa Naavaal

Dental Public Health and Policy Publications

Introduction: This study examined the cost-effectiveness and health impact of various dental sealant resealing scenarios for first permanent molars from the payer perspective.

Methods: The authors used a discrete event simulation model for 4,000 recently sealed first molars in a hypothetical cohort of 1,000 children aged 7 years over a 10-year time horizon. Scenarios included a base case of no resealing, resealing at first dental visit, and resealing at the age of 12 years.

Results: Without resealing, only 34.88% of teeth retained sealants after 10 years, whereas resealing at the age of 12 years increased this to …

Role Of Oral Health Providers In Supporting Hpv-Related Cancer Prevention In The Dental Setting, Megan Cloidt, Sarah Vivo, Aubree Thelen, Shillpa Naavaal

Dental Public Health and Policy Publications

Background: Human papillomavirus (HPV) vaccination can prevent HPV-related illness and associated cancers, including oropharyngeal. The safety and efficacy of HPV vaccination has been well-established, but national HPV vaccination rates remain unacceptably low with persistent disparities for certain populations. While vaccination has been one of the biggest public health accomplishments of the last century, vaccine hesitancy continues to grow in the United States, and remains a challenging element of low HPV vaccine uptake.

Description: Oral health providers have been traditionally siloed and largely uninvolved in vaccination counseling and administration, but the COVID-19 pandemic brought oral health providers, pharmacists and …

Effectiveness Of School Fluoride Delivery Programs: A Community Guide Systematic Review, Susan O. Griffin, Mei Lin, Christina Scherrer, Shillpa Naavaal, David P. Hopkins, Anita A. Jones, Tammy Alexander, Virginia A. Black, Elizabeth Clark, Lori K. Cofano, Raúl Isidro García, Anna Goddard, Jane Grover, Susan M. Kansagra, Thomas E. Kottke, Elizabeth C. Lense, Tooka Zokaie, The Community Preventive Services Task Force

Dental Public Health and Policy Publications

Introduction: Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs in preventing caries.

Methods: Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on school flouride varnish delivery program effectiveness in increasing fluoride varnish receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle– or high-income countries. Data synthesis conducted in 2024 used median …

Improving Dental Hygiene Students' Knowledge, Attitudes, And Confidence Toward Prenatal Oral Health Through Experiential Learning, Denise C. Mckinney, Sinjini Sikdar, Shillpa Naavaal

Dental Public Health and Policy Publications

Purpose Maintaining optimal oral health is essential for maternal health as well as the health of their child. The purpose of this pilot study was to examine dental hygiene (DH) students' knowledge of prenatal oral health before and after receiving an asynchronous prenatal oral health care training (POHCT), and their attitudes and self-perceived confidence before and after receiving an experiential learning opportunity with a pregnant and/or post-partum client at a Women's Infants and Children nutrition program (WIC) clinic.

Methods A one-group pre/post-test design was used. This IRB-approved study (#2027439-4) utilized a convenience sample of DH student participants (n=37) in their …

Perceptions Of A State-Level Hpv Vaccine Mandate And Exemption Option In Rural Virginia: A Qualitative Study, E. Marshall Brooks, Kendall Fugate-Laus, Ben Webel, Shillpa Naavaal

Dental Public Health and Policy Publications

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with …

Describing Trends In Virginia's Dentist And Dental Hygienist Workforce: Challenges And Opportunities, Shillpa Naavaal, Yetty Shobo, Barbara Hodgdon

Dental Public Health and Policy Publications

Purpose: Regular assessment of the dental workforce is essential to improve the population's oral health. This analysis aimed to understand the trends in the distribution of dentists and dental hygienists (DHs) in Virginia.

Methods: Annual survey data (2013-2022) of dentists and DHs from the Virginia Department of Health Professions Healthcare Workforce Data Center was used to examine the trends in provider distribution by age, gender, race/ethnicity, and geography across Virginia.

Results: In 2022, there were 5,720 dentists and 5,290 DH licensees in Virginia. In the dentist workforce, there was a high representation of those aged ≥60 years …

Health, Beliefs, And Faith: Hpv Vaccine Uptake Intent Among Catholic, Evangelical, And Mainline Protestant Parents, Jeanine P.D. Guidry, Shillpa Naavaal, Linnea I. Laestadius, Carrie A. Miller, Gina Zurlo, Candace W. Burton, Kellie E. Carlyle, Julie Russo, Paul B. Perrin

Dental Public Health and Policy Publications

The HPV vaccine has the potential to prevent nearly 92% of HPV-related cancer cases, yet its uptake remains suboptimal. While well-documented barriers to HPV vaccine uptake include inadequate knowledge and lack of provider recommendation, religious preferences have emerged as another crucial factor influencing vaccination decisions. This study examined the interrelatedness of religion, beliefs, and HPV vaccination uptake among children among Catholic, Evangelical, and Mainline Protestant parents. A nationally representative survey was conducted among 1,068 U.S. parents from one of three major Christian denominations: Catholic, Evangelical, or Mainline Protestant. We examined the extent to which demographic factors, constructs from the Health …

Implementation Of A Cancer Education Program In Rural Counties With The Lowest Hpv Vaccination Rates And Health Rankings, Sarah Arezo, Shillpa Naavaal, Charlotte Garrett, Marcie S. Wright, Vanessa B. Sheppard, Michael A. Preston

Dental Public Health and Policy Publications

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods. Methods: We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students’ …

Perceptions About Human Papillomavirus Vaccine And Oropharyngeal Cancers, And The Role Of Dental Care Providers In Human Papillomavirus Prevention Among Us Adults, Shillpa Naavaal, Christina A. Demopoulos, Abigail Kelly, Eric Tranby, Julie Frantsve-Hawley

Dental Public Health and Policy Publications

Background: The authors examined adults' perceptions about the importance of the human papillomavirus (HPV) vaccine in preventing oropharyngeal cancers and dental care providers' role in HPV prevention and identified associated factors.

Methods: Adults (≥ 18 years) completed a national survey of consumer and patient attitudes, experiences, and behaviors on oral health. Descriptive and multivariable logistic regression models determined associations between perceptions regarding HPV and attitudes toward dental care providers' role and HPV knowledge, HPV vaccine recommendation, and sociodemographic characteristics.

Results: One in 3 adults (32.8%; n = 5,320) said the HPV vaccine was very important, 1 in 2 said it …

Covid-19 Pandemic Impact On Us Childhood Caries And Potential Mitigation, Christina Scherrer, Shillpa Naavaal, Susan O. Griffin, Mei Lin

Dental Public Health and Policy Publications

Non-Hispanic Black (NHB) and Hispanic and low-income US children have a higher prevalence of untreated caries than their higher-income and non-Hispanic White (NHW) counterparts. Due to the COVID-19 pandemic, many dental offices and school sealant programs closed beginning March 2020. We examine the effect of reduced access to restorative care and sealants on the oral health of children from low-income households overall and by race/ethnicity and how increased sealant delivery in September 2022 could mitigate these effects. We used Markov chain Monte Carlo simulation to model COVID-19’s impact on first permanent molar (1M) caries incidence and loss in quality of …

Comprehensive Pregnancy Dental Benefits Improved Dental Coverage And Increased Dental Care Utilization Among Medicaid-Enrolled Pregnant Women In Virginia, Shillpa Naavaal, David W. Harless

Dental Public Health and Policy Publications

Objectives: To evaluate the changes in dental insurance and utilization among pregnant women before and after the pregnancy Medicaid dental benefit policy implementation in 2015 in Virginia.

Methods: We used pooled cross-sectional data from six cycles of the Virginia Pregnancy Risk Assessment Monitoring System on women aged ≥21 years. Using logistic regression models and a difference-in-difference design, we compared the effects of policy implementation on dental insurance and utilization between pre-policy (2013-2014) and post-policy period (2016-2019) among women enrolled in Medicaid (treatment, N = 1,105) vs. those with private insurance (control, N = 2,575). A p-value of 0.05 was …

Association Between Periodontal Disease And Oral Cancer Screening Among Us Adults: Nhanes 2011-2014, Shillpa Naavaal, Dina T. Garcia, Xiaoyan Deng, Dipankar Bandyopadhya

Dental Public Health and Policy Publications

Objectives:

To examine oral cancer screening rates and associated factors among adults with periodontal disease (PD). We hypothesized that adults with severe PD will be less likely to report receipt of any type of oral cancer screening than adults with no PD.

Materials and Methods:

We used 2011-2014 National Health and Nutrition Examination Survey (NHANES) data on adults ≥ 30 years. PD status was classified as no PD, mild/moderate PD, and severe PD. Survey-adjusted logistic regression analysis was used to examine the model adjusted risk ratio (RR) and 95% confidence intervals (CI) for the outcome of not receiving intraoral, extraoral …

The Contribution Of Different Permanent Tooth Types To Untreated Caries: Implications For Public Health Surveillance And Prevention, Susan O. Griffin, Liang Wei, Shillpa Naavaal, Eleanor Fleming

Dental Public Health and Policy Publications

Background: Untreated caries (UC), although highly prevalent, is largely preventable. Information on the contribution of different teeth to UC prevalence and severity could be helpful in evaluating UC surveillance protocols and the relative benefits of caries prevention interventions.

Methods: The authors combined data from 3 cycles (2011-2016) of the National Health and Nutrition Examination Survey for participants aged 6 through 11 years, 12 through 19 years, 20 through 34 years, 35 through 49 years, 50 through 64 years, 65 through 74 years, and 75 years and older. For each age group the authors calculated the contribution of successive permanent tooth …

For Medicaid Beneficiaries, The Ability To Find A Dentist Is A Key Component Of Access To Care, Julie C. Reynolds, Shillpa Naavaal

Dental Public Health and Policy Publications

No abstract provided.

Opioid And Nonopioid Analgesic Prescriptions For Dental Visits In The Emergency Department, 2015-2017 National Hospital Ambulatory Medical Care Survey, Shillpa Naavaal, Uma Kelekar, Shital Shah

Dental Public Health and Policy Publications

Introduction: Prescription and nonprescription opioid misuse and the rising number of dental visits in emergency departments (EDs) are growing public health concerns in the US. Our study objective was to examine the relationship between prescription analgesics (opioids and nonopioids) and the type of ED visits (dental and nondental) at the national level.

Methods: We used data from the 2015-2017 National Hospital Ambulatory Medical Care Survey to examine the association between opioid, nonopioid, and combination of opioid and nonopioid analgesic prescriptions and dental and nondental visits in the ED. Covariates included socioeconomic variables, time of visit, provider type, triage level, hospital …

Lifestyle Risk Factor Related Disparities In Oral Cancer Examination In The U.S: A Population-Based Cross-Sectional Study, Aderonke A. Akinkugbe, Dina T. Garcia, Tegwyn H. Brickhouse, Maghboeba Mosavel

Dental Public Health and Policy Publications

Background: Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination.

Methods: Adult participants ≥30 years (n = 9374) of the 2013–2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression …

Impact Of Making Dental Care Affordable On Quality Of Life In Adults Aged 45 Years And Older, Shillpa Naavaal, Susan O. Griffin, Judith A. Jones

Dental Public Health and Policy Publications

Objective:

The objective of this study was to examine the associations between self-reported ability to afford dental care and quality of life in adults aged 45 years and older.

Method:

We used publicly available cross-sectional data from the 2008 National Health Interview Survey and its oral health supplement for 11,760 adults aged 45+ years. The increased probabilities of reporting dental problems attributable to an inability to afford dental care were estimated from multivariate models and combined with respective dental problem disability weights from the Global Burden of Disease to measure loss in quality of life.

Results:

Prevalence of reported inability …

Self-Reported Oral Health Status Among Adults Aged 40+ Years With And Without Vision Impairment: National Health Interview Survey, 2008, John E. Crews, Chiu-Fang Chou, Shillpa Naavaal, Susan O. Griffin, Jinan B. Saaddine

Dental Public Health and Policy Publications

Purpose: To examine self-reported oral health among adults aged 40 years and older with and without vision impairment.

Design: Cross-sectional, with a nationally representative sample.

Methods: We used publicly available data from the Oral Health Module, last administered in 2008, of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath, and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked, or stained teeth; and/or bleeding gums), and lack of social participation. Using descriptive statistics and multivariate logistic …

Oral Cancer Has A New Risk Factor: Hpv, Tira Hanrahan, Shillpa Naavaal

Dental Public Health and Policy Publications

No abstract provided.

Hours Lost To Planned And Unplanned Dental Visits Among Us Adults, Uma Kelekar, Shillpa Naavaal

Dental Public Health and Policy Publications

Introduction

Poor oral health is associated with lost hours at work or school, which may affect a person’s productivity. The objective of our study was to estimate work or school hours lost to dental visits among adults aged 18 and older by the types of visits (emergency or unplanned; routine, planned, or orthodontic; or cosmetic) and to determine the factors associated with hours lost.

Methods

We used the most recent Oral Health Supplement data, from the 2008 National Health Interview Survey (NHIS), to estimate the total hours lost at work or school for dental visits among adults in the United …

Estimating The Cost Of School Sealant Programs With Minimal Data, Susan O. Griffin, Kari Jones, Shillpa Naavaal, Joan M. O'Connell, Christina Demopoulos, Dawn Arlotta

Dental Public Health and Policy Publications

Objective: Develop methodology to estimate the annual cost of resources used by school sealant programs (SSPs) and demonstrate its use.

Methods: We used existing literature and expert opinion to identify SSP cost components and the most appropriate units for their measurement (e.g., per operator) and collection frequency (e.g., per day). For equipment and reusable instruments, costs were sufficiently homogenous across SSPs that we could provide default per unit cost estimates (2016 US$) that SSPs can use in lieu of collecting their own data. We also provide default costs for supply items such that SSPs can estimate total supply costs with …

Variations In Cigarette Smoking And Quit Attempts By Health Insurance Among Us Adults In 41 States And 2 Jurisdictions, 2014, Shillpa Naavaal, Ann Malarcher, Xin Xu, Lei Zhang, Stephen Babb

Dental Public Health and Policy Publications

Objectives: Information on the impact of health insurance on smoking and quit attempts at the state level is limited. We examined the state-specific prevalence of cigarette smoking and past-year quit attempts among adults aged 18-64 by health insurance and other individual- and state-level factors.

Methods: We used data from 41 states, the District of Columbia, and Puerto Rico, the jurisdictions that administered the Health Care Access module of the 2014 Behavioral Risk Factor Surveillance System. Data on quit attempts included current smokers with a past-year quit attempt and former smokers who quit during the past year.

Results: Overall, smoking prevalence …

School Hours Lost Due To Acute/Unplanned Dental Care, Shillpa Naavaal, Uma Kelekar

Dental Public Health and Policy Publications

Objective: We estimated the school-hours lost for acute/unplanned dental care and examined the associated factors among children aged 5-17 years using 2008 National Health Interview Survey data.

Methods: We used bivariate and multivariate regression models to investigate the associations between school hours lost and socioeconomic and oral health factors (p < .05).

Results: Acute/unplanned dental care accounted for a loss of 34 million school-hours annually. Compared to children with very good oral health, children with fair/poor oral health were 2.8 times more likely to lose ≥1 hours. Children in high-income families had 31% less likelihood of losing any school …

Prevalence Of Past-Year Dental Visit Among Us Adults, 1999– 2010: Comparison Of Trends And Estimates Between The Behavioral Risk Factor Surveillance System And Three National Surveys, Mei Lin, Chen-Hsun Li, Liang Wei, Shillpa Naavaal, Shellie Kolavic Gray, Michael C. Manz, Laurie Barker

Dental Public Health and Policy Publications

Objectives: To compare estimated prevalence of past-year dental visit (PPYDV) among US adults aged ≥18 years from the Behavioral Risk Factor Surveillance System (BRFSS) to estimates from the Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), and National Health and Nutrition Examination Survey (NHANES).

Methods: We estimated PPYDV adjusted for covariates (age, race/ethnicity, education level, poverty status, edentulism) using BRFSS, MEPS, and NHIS 1999-2010, and NHANES 1999-2004. We tested trend in overall PPYDV for BRFSS, MEPS, and NHIS from 1999-2010. For 2002 and 2010, we calculated absolute differences (AD) and 95% confidence intervals (CI) in PPYDV between BRFSS …

The Effect Of Health And Dental Insurance On Us Children’S Dental Care Utilization For Urgent And Non-Urgent Dental Problems - 2008, Shillpa Naavaal, Laurie K. Barker, Susan O. Griffin

Dental Public Health and Policy Publications

Objective: We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage.

Methods: We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had …

Evaluation Of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review, Susan O. Griffin, Shillpa Naavaal, Christina Scherrer, Mona Patel, Sajal Chattopadhyay

Dental Public Health and Policy Publications

Context

A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review.

Evidence acquisition

Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies—ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); …

School-Based Dental Sealant Programs Prevent Cavities And Are Cost-Effective, Susan Griffin, Shillpa Naavaal, Christina Scherrer, Paul M. Griffin, Kate Harris, Sajal Chattopadhyay

Dental Public Health and Policy Publications

Untreated cavities can have far-reaching negative consequences for people's ability to eat, speak, and learn. By adolescence, 27 percent of low-income children in the United States will have untreated cavities. School-based sealant programs typically provide dental sealants (a protective coating that adheres to the surface of molars) at little or no cost to students attending schools in areas with low socioeconomic status. These programs have been shown to increase the number of students receiving sealants and to prevent cavities. We analyzed the cost-effectiveness of school sealant programs using data (from school programs in fourteen states between 2013 and 2014) on …

Relationship Between Untreated Dental Caries And Weight And Height Of 6- To 12-Year-Old Primary School Children In Bangladesh, Masuma Pervin Mishu, Martin Hobdell, Mahfujul Haq Khan, Richard M. Hubbard, Wael Sabbah

Dental Public Health and Policy Publications

Background. Children in low-income developing countries are likely to suffer from undergrowth. Dental caries is another common problem in these countries. Aim. To examine the association between untreated dental caries in primary and permanent teeth with age-adjusted height and weight among 6–12-year-old children in Bangladesh. Design. Social, behavioural, and clinical data were collected from 1699 children in nine different randomly selected primary schools in socially deprived areas of Bangladesh. The associations of age-adjusted weight and height and being underweight with dental caries were examined adjusting for sex, area of residence, socioeconomic position, skipping meals, tooth cleaning, and …