Christopher Okunseri

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub‐Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low‐ and middle‐income countries (LMICs) are exacerbated by these challenges, with sub‐Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

Objective: The study examined changes in acculturation level, socio‐economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs.Methods: Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross‐sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio‐economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator.Results: Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio‐economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization.Conclusion: Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio‐economic status.

Objective: To describe current Dental Public Health diplomates and list the competency domains that diplomates considered either essential or optional elements of their practice.Methods: The American Board of Dental Public Health administered an electronic survey to active and life member diplomates during September 2021. The survey included 101 items in three sections: (1) Education and Work Experience; (2) Dental Public Health Tasks; and (3) Demographics. The Dental Public Health Tasks section asked individuals how essential work‐related tasks were to their current practice. Descriptive analyses were conducted using SAS.Results: The overall response rate was 82.6% (157 eligible of 190 returned). Most respondents were women, 35 to 54 years of age, and either non‐Hispanic white or non‐Hispanic Asian. Twice as many had DDS or DMD degrees than BDS degrees. The vast majority completed a Dental Public Health residency and received masters level training from an accredited program. About three‐fourths worked in the United States and held a U.S. license. More than 37% reported a second doctoral degree and 70% worked in academia. Responses to questions about tasks closely aligned with working in academia and less so with positions related to advocacy, regulation, and program evaluation.Conclusions: Current diplomates are concentrated in academia. If this trend continues, it may be necessary to restructure the competencies, so training and skills acquisition remain timely and relevant. The specialty may also need to encourage future generations to consider non‐academic positions so Dental Public Health remains an impactful component of the public health care system.

Objective To compare the use of Medicaid and commercial claims data with self-reported survey data in estimating the prevalence of oral disease burden. Methods We analyzed 2018 Medicaid claims from the IBM Watson Medicaid Marketscan database, commercial claims from the IBM Dental Database, and Medical Expenditure Panel Survey (MEPS) data. The estimate of oral disease burden was based on standard metrics using periodontal and caries-related Current Dental Terminology (CDT) procedure codes. A direct comparison between the data sets was also done. Results Unweighted Medicaid and commercial enrollees were 11.6 and 10.5 million, respectively. The weighted proportion from MEPS for Medicaid and commercial plans ranged from 80 to 208 million people. Estimates of caries-related treatments were calculated from IBM Watson and MEPS data for Medicaid enrollees (13% vs. 12%, respectively) and commercial claims (25% vs. 17%, respectively). Prevalence of periodontal related treatments for those with a dental visit was estimated for IBM Watson and MEPS enrollees for Medicaid (0.7% vs. 0.5%, respectively) and commercial claims (7% vs. 1.6%, respectively). Dental disease estimates were higher in individuals with at least one dental visit across cohorts. Prevalence of disease for those with a dental visit based on specific procedures were higher in commercial plans than in Medicaid. Conclusions Claims data has the potential to serve as a proxy measure for the estimate of dental disease burden in a population.

Background: By midcentury, the US population will be remarkably more racially and ethnically diverse, with a dramatic increase in the proportion of older adults. This report addresses ongoing oral health disparities and inequitable access to care related to these changes, with emphasis on implications for the workforce, taking note of effects of the COVID-19 pandemic. Relevant Considerations: Considering that social determinants shape health behaviors, reflection on the most effective type of dental workforce should take into account population characteristics and the relationship of oral health with overall health and general well-being. The dental workforce composition will need to mirror changing demographics, and effective dental health teams will be characterized by cultural competence, humility, readiness, and capacity to adapt to changes. In addition, the influence of social histories and the pandemic on health and dental care utilization is important. Equally important are the inclusion of oral health literacy in treatment planning and disease prevention, as well as oral health–related quality of life in considering outcomes of care. Providing patient-centered care for a diverse population requires tailored treatment modalities, as well as intra- and interprofessional approaches. In this way, the whole person can be cared for, including those with special health care needs, whether related to chronic disease, mental health conditions, or behavioral, physical, and social differences. Conclusions: Changing demographics will affect the delivery of oral health care, including who can best provide care and how, what the needs are, and in what ways prevention and treatment can most effectively be accomplished. The education of dentists must address unmet population needs, including for those with special health care concerns and older adults. These population groups are influenced by a variety of social determinants, and provision of services may need to occur in alternative care delivery settings. Identifying and addressing the needs of every patient within this broad array of new requirements will challenge dental professionals to redefine what it means to be a health care practitioner. Knowledge Transfer Statement: This article describes how sociodemographic changes in the United States will challenge the dental workforce in new ways and points to research and practice needs to address these challenges. Oral health disparities and the changing oral health care needs of patients from diverse and underserved groups are discussed, with a focus on the implications for delivery of care and policies that are needed to improve oral health outcomes for all.

Objectives: Individuals with disabilities experience greater barriers accessing health care services and have poorer oral health outcomes than those without disabilities. The aims of this study were to examine dental access, utilization, expenditures, and sources of payment between adults with intellectual disabilities (ID), other types of disabilities, and without disabilities.Methods: Secondary analyses of data from the 2017 Medical Expenditure Panel Survey (MEPS) allowed examination of dental access (being able to get dental care and receiving necessary dental care without delay), dental utilization (having a dental visit in the past year), total dental expenditures, and associated sources of payment between three groups of adults based on disability status using descriptive, bivariate, and multivariable statistics.Results: Adults with ID have 2.70 (95% CI: 2.03, 3.61) times the odds of being unable to get dental care and 2.88 (95% CI: 2.11, 3.94) times the odds of having to delay necessary dental care compared with adults without disabilities. No significant differences were observed in dental utilization or mean total dental expenditure between the three groups after adjusting for demographic and socioeconomic variables. Among adults who incurred a dental expenditure, adults with ID had a greater share of dental care paid for by Medicaid, and adults without disabilities had a greater share of dental care paid for by private insurance.Conclusions: Despite similar mean total dental expenditures, reduced dental access reported by adults with ID suggests that this population experiences significantly greater challenges obtaining dental care. Adults with ID rely more heavily on Medicaid to finance dental care.

Objective To examine the use of Medicaid, commercial claims, and self-reported survey data to estimate the prevalence of oral disease burden. Methods We analyzed 2018 Medicaid claims from IBM Watson Medicaid Marketscan database, commercial claims from the IBM Dental Database, and Medical Expenditure Panel Survey (MEPS) data. The estimate of oral disease burden was based on standard metrics using periodontal and caries-related treatment procedure codes. Examples are restorations: D2000-D2999, root Canals: D3230 – D3334, periodontics: D4000 – D4999, prosthodontics: D5000 – D6999 and extractions: D7000 - D7251. A direct comparison between the data sets was also done. Enrollees from the different databases were broken down by gender, race/ethnicity, and into age groups. Results Medicaid and commercial enrollees were 11.6 million and 10.5 million. The weighted proportion from MEPS for Medicaid and commercial plans ranged from 80-208 million people. Prevalence of caries-related treatments was estimated for IBM Watson and MEPS for total enrollees for Medicaid (13% vs. 12%); and commercial claims (25% vs. 17%), respectively. Prevalence of periodontal related treatments was estimated for IBM Watson and MEPS total enrollees for Medicaid (0.7% vs. 0.5%) and commercial claims (7% vs. 1.6%), respectively. Prevalence of dental diseases was higher in patients with at least one visit for Medicaid, commercial plans, and MEPS. Prevalence based on specific procedures were higher in commercial plans than in Medicaid. Conclusions Claims data has the potential to serve as a proxy measure for the estimate of dental disease burden in a population. In addition, in rare events, claims data provides a better estimate of disease burden because it is based on a larger dataset.

Objectives: To test the feasibility and preliminary effectiveness of the NIATx model for organizational change to reduce appointment no‐shows in dental care settings.Methods: The NIATx Dental Pilot Study used a clustered prepost interventional design and a mixed‐methods approach. Five independent dental clinics serving Medicaid enrollees were recruited. Quantitative data on the impact of the NIATx model were complemented by qualitative assessment information collected from dental staff. The NIATx model was applied through a multisite learning collaborative that engaged participating organizations in adopting targeted no‐show best practices. The primary outcome measure was no‐show data collected at the preintervention phase (5 months), intervention phase (7 months), and postintervention phase (3 months).Results: Female patients were in the majority (median 54.5 percent). Mean age ranged from 8 to 50 (median 35.2) years. The median percentage for Hispanics was 11.0 percent, and the proportion of uninsured patients was 25 percent. Preintervention no‐show rates ranged from 14 percent (clinic B) to 38 percent (clinic E). All clinics had lower no‐show rates during the postintervention period, with decreases ranging from 1 percent (clinic B) to 13 percent (clinic E). Overall, the no‐show rates decreased in the study.Conclusions: The study demonstrated the feasibility of applying the NIATx model to reduce no‐show rates, with some difficulty observed with sustainability across dental practices during the postintervention period.

Objectives: To determine the patterns and time trends of dental services received and access to dental care among immigrant and US‐born children living in the United States.Methods: We analyzed the nationally representative Medical Expenditure Survey data for 2007–2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received.Results: Overall 34,482 children aged P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US‐born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100‐person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups.Conclusion: Stratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures.

Objective: To investigate geographical variations and their relationship to race/ethnicity in dental sealant utilization for first molars among Wisconsin Medicaid enrollees from 2010 to 2013.Methods: Wisconsin Medicaid dental claims for sealants in children aged 6‐16 years were analyzed. County‐level population density, urban influence code, presence of dental health professional shortage areas, and population‐per‐dentist ratio were considered as geographic predictors. Descriptive statistics and mixed effects Poisson regression models were used to examine the effect of county level covariates on the number of dental sealants received per person‐year (PY) of eligibility adjusting for patient‐level characteristics. Over‐dispersion was modeled by a random residual effect, and all models adjusted for single‐year age and gender interaction and race/ethnicity main effect.Results: Medicaid claims for sealants on first permanent molars for 2010–2013 totaled 288,019 over 1,130,000 PY. The age‐ and gender‐standardized rate of first molar sealant applications per 100 PY were 27.9, 25.7, and 16.6 for White, Hispanic, and Black children, respectively. County‐specific rates ranged from a low of 8.9 per 100 PY to a high of 62.6 per 100 PY. In the multivariate analysis after adjusting for geography, compared to Whites, Hispanics had highest rates (rate ratio (RR) = 1.33, 95% CI = 1.30‐1.37) of dental sealant utilization followed by Blacks (RR = 1.25, 95% CI = 1.21‐1.29). Population density was the only significant geographic predictor (RR = 0.56 per 10‐fold increase, 95% CI = 0.45‐0.69).Conclusions: Substantial geographic variability in the utilization of sealants for first molars was identified. Lower population density was the main geographical predictor of high sealant utilization.