RESUMEN
BACKGROUND: One approach to addressing oral health disparities for at-risk populations has been to increase discussion of oral health by non-dental healthcare providers. This study examined the accuracy of a simple instrument to detect individuals with a history of dental disease, which would then allow referral for an oral health evaluation. MATERIALS AND METHODS: A two-question instrument was evaluated for the relationship to oral diseases, periodontal disease, and decayed, missing and filled teeth in 391 individuals seen in a dental school clinic for non-emergent dental care over a 3-month period. Clinical dental findings were used as outcome variables. The oral health parameters were dichotomised, using different levels of disease severity. The criteria were increased and decreased in an effort to test the robustness of our method. RESULTS: While the sensitivity outcomes with one question alone showed significant ability to predict oral disease (59-71%), the addition of a second self-assessment question increased the sensitivity (76-91%) for all oral health parameters studied. As the criteria for oral disease increased so did the sensitivity of this instrument. CONCLUSION: The results presented here offer evidence that a simple two-item questionnaire is an efficient and effective method of detecting populations at-risk for oral diseases.
Asunto(s)
Encuestas de Salud Bucal , Autoevaluación Diagnóstica , Enfermedades de la Boca/diagnóstico , Salud Bucal , Autoinforme , Adulto , Anciano , Anciano de 80 o más Años , Índice CPO , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Higiene Bucal , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: The identification of persons with or at risk for chronic diseases is a new practice paradigm for oral healthcare. Diabetes mellitus (DM) is a chronic disease of particular importance to oral health providers. This study sought to understand healthcare utilization patterns that would support the introduction of this new practice paradigm. METHODS: The primary and oral healthcare utilization patterns of New York City (NYC) adults were assessed using data collected from the 2013 NYC Community Health Survey. We stratified healthcare utilization patterns by type of provider, insurance, DM diagnosis and DM modifiable risk factors. RESULTS: Of 6.4 million NYC adults, an estimated 676 000 (10.5%) reported a previous diagnosis of DM, and 3.9 million (69.5%) were identified with one or more modifiable risk factor for DM. Of these at risk individuals, 2.2 million (58.9%) received dental services in the past 12 months, and 545 000 (14.3%) did not see a primary care provider during the same period. Of the approximately 1.16 million adults without health insurance, an estimated 338 000 (26.2%) had a dental visit only. CONCLUSION: Healthcare utilization patterns in this urban setting suggest that oral healthcare providers can support the identification of patients with and at risk for DM who may otherwise not have the opportunity for screening.
Asunto(s)
Atención Odontológica , Diabetes Mellitus/diagnóstico , Visita a Consultorio Médico , Adolescente , Adulto , Factores de Edad , Anciano , Atención Odontológica/métodos , Atención Odontológica/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Visita a Consultorio Médico/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores de Riesgo , Adulto JovenRESUMEN
The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century."
Asunto(s)
Atención a la Salud/tendencias , Odontología/tendencias , Salud Bucal , Prestación Integrada de Atención de Salud , Predicción , Promoción de la Salud , Humanos , Atención Primaria de Salud , Estados UnidosRESUMEN
UNLABELLED: The oral health care paradigm presented here would broaden oral health services to include primary health care activities focusing on risk reduction and chronic disease screening. BACKGROUND AND PURPOSE: Changes in our nation's health care delivery system, shifting patient demographics, and availability of new health insurance programs have resulted in exploration of new practice models of health care delivery. Chronic diseases require coordinated care efforts over decades of a patient's life. Oral health professionals will be part of that care. METHODS: The practice model for this article was developed in the context of an academic medical center that promotes oral health care professionals as health care providers through interprofessional education. The combined experiences of the authors, including a diabetes predictive model for oral health settings, the efficacy and effectiveness of human immunodeficiency virus screening in a dental setting, the feasibility of using a decision support tool for tobacco cessation, and the effectiveness of integrating oral health education with comprehensive health services for people living with human immunodeficiency virus, have contributed to this concept. CONCLUSIONS: Prevention is increasingly recognized as a cost-effective means of reducing chronic disease burdens. To be effective, health promotion activities that encourage healthy living and early detection need to occur in a variety of health care settings. Oral health professionals represent an underutilized group of health care providers that can contribute to improved health of populations living with chronic diseases by broadening their scope of practice to include primary health screenings and tailored health promotion activities.