Pediatric Oral Health Research and Policy Center

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Mission Statement

To inform and advance research and policy development that will promote optimal children’s oral health and care.


Activities of the Pediatric Oral Health Research and Policy Center

  • Conduct oral health policy research that advances children’s oral health issues and supports AAPD public policy and public relations initiatives at the national, state, local, and international levels with legislatures, government agencies, professional associations, and other non-governmental organizations.
  • Monitor and reports on state, national, and international data concerning the oral health status and overall health status of children
  • Develop and implement special project activities that advance children’s oral health issues and public understanding of such, in accordance with AAPD policies and guidelines
  • To produce timely and high quality policy analysis on critical issues impacting children’s oral health.
  • To produce useful studies and analysis to further the understanding of practices which will contribute to the oral health of all children

Director's Commentary

We are pleased to introduce a new feature called "Commentary" by the AAPD Pediatric Oral Health Research and Policy Center’s Director Dr. Paul S. Casamassimo. Each Commentary will offer Casamassimo’s concise and insightful perspective on a current research or policy issue impacting children’s oral health.  They will be disseminated not only to AAPD members but to other dental organizations and key policymakers.  His first Commentary is entitled "Minnesota Dental Therapist Evidence to Date is Underwhelming."


Technical Briefs

Patient-Centered Care

The AAPD Pediatric Oral Health Research and Policy Center’s (POHRPC) most recent Technical Brief addresses the topic of patient-centered care in the context of increasing rates of dental caries in pre-school children, limited resources and a potential increase in patient demand due to the provisions of the Affordable Care Act.

Click here to download the technical brief.

An Essential Health Benefit: General Anesthesia for Treatment of Early Childhood Caries

The AAPD Oral Health Policy and Research Center is pleased to announce the publication of a Technical Report: An Essential Health Benefit: General Anesthesia for Treatment of Early Childhood Caries. The report provides information in support of the assertion that General Anesthesia may be a medically necessary when treating some dental patients and, therefore, should be included as an essential health benefit under both public and private medical insurance coverage for children.

Click here to download the technical brief.

Considerations for Caries Risk Assessment in an Essential Health Benefits Dental Plan for Children

The AAPD Pediatric Oral Health Research and Policy Center is pleased to announce the publication of a Technical Brief: Considerations for Caries Risk Assessment in an Essential Health Benefits Dental Plan for Children, which provides an overview of the current research on caries risk assessment, and its potential to improve its use in clinical care of children. Recommendations and consideration related to the use of caries risk assessment in an essential dental benefits plan are discussed as they relate to current scientific evidence is reviewed.

Click here to download the technical brief.

The Use of Case Management to Improve Dental Health in High-Risk Populations

The combination of patient and provider barriers leads to low utilization of dental care options by publically insured pediatric patients, higher dental disease rates and treatment costs. Only by overcoming barriers to care will these children receive cost-effective preventive as well as therapeutic care. 

Click here to download the technical brief.

 

Policy Center Receives Renewal of DentaQuest Foundation Grant for Year Two

The American Academy of Pediatric Dentistry’s Pediatric Oral Health and Policy Research Center has been awarded another one year grant from the DentaQuest Foundation to continue their research on oral health promotion in the primary care setting. The first year of the study was used to gathered information and insight regarding current implementation of oral health promotion in primary care. This was done through focus groups, practice observations, and surveys. The focus for the second year will be on Common Risk Factors. 

Presently, there is no simple caries-risk assessment (CRA) based primarily on visual inspection and risk factors identified in the general medical history in the electronic health record (EHR). Nationwide Children’s Hospital (Columbus, OH) has an EPIC EHR system that fully integrates dental with general pediatrics and pediatric specialties.  The availability of this data offers the unique opportunity to identify and evaluate relationships across the span of medical, dental and social services provided to children. The identification of global factors that earmark at risk children for multiple problems, including dental caries, through the analysis of electronic data variables has the potential to transform the CRA process. 

Click here to download a copy of the abstract.

 

The Interprofessional Study of Oral Health in Primary Care Final Report is Now Available

"Doing visual [oral] screenings triggers in my mind to ask, "When was the last time your child went to the dentist?"

The AAPD Pediatric Oral Health and Policy Research Center released the results of a year-long study, funded by DentaQuest Foundation, which studied oral health promotion in primary care settings. The Center collaborated with representatives from the following organizations: the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American Academy of Physician Assistants (AAPA), the National Association of Pediatric Nurse Practitioners (NAPNAP), and the National Interprofessional Initiative on Oral Health (NIIOH).  The year-long study included focus groups and observations of primary care practices that have implemented oral health promotion activities.  The report provides an overview of how primary care offices are implementing these activities, drivers to successful implementation and recommendations for future activities.

Click here to view the entire report.
 

2014 Trends in Pediatric Dentistry

View the most recent information about how Pediatric Dentists practice in the United States. Includes information on how Pediatric Dentists are stepping up to the plate to serve as a significant portion of the dental safety net for Medicaid and uninsured children.

Click here to download the presentation.


2014 Child Snapshot

The presentation provides information about key national indicators of child health and well-being. Data sources are identified that provide comprehensive information on economic status, demographics, safety and health of America’s children. Key information relating to access and utilization of dental services is presented.

Click here to download the presentation.

CDC recently published a data brief on dental indicators including children.

Annually, the Federal Interagency Forum on Children and Family Statistics publishes the report America’s Children: Key national indicators of well-being. One of the indicators in the report is on children’s oral health. Click here to access the 2013 report. See the Health Care section, pages 24-25.


AAPD Responds to US Preventive Task Force Draft Recommendation Statement on Prevention of Dental Caries

The U.S. Preventive Services Task Force posted its draft Evidence Report and draft Recommendation Statement on prevention of dental caries in children from birth through age 5 years. Both were available for review and public comment from May 21 through June 17, 2013. As the leading authority on children’s oral health, the American Academy of Pediatric Dentistry is a proponent for evidence based dental care and prevention activities; therefore, it is incumbent on the AAPD to provide feedback and input to government reports as the opportunity becomes available. The above referenced recommendation statement and evidence report emphasized the role of fluoride in the prevention of dental caries. Additionally it addessed risk assessment and oral care activities performed by primary care providers (medical practitioners).

Review the AAPD response here.

Review the draft Evidence Report and draft Recommendation Statement and submit comments.


Characteristics of Pediatric Dentists:  Results of the ADA-AAPD Survey of Dental Practice

The results of the Survey of Dental Practice, a collaboration of the American Academy of Pediatric Dentistry Pediatric Oral Health Research and Policy Center and the American Dental Association’s Health Policy Resources Center, are now available on the AAPD website.  Results from the survey indicate that pediatric dentists are reflective of the population and that they are committed to serving that population through effective and efficient care for all.  Highlights include:

  • over half of the pediatric dentists accept new Medicaid patients, demonstrating the profession’s support for socioeconomically disadvantaged pediatric dental patients—25.5 percent of patients in pediatric dental offices are on public assistance while 15.4 percent have no coverage.
  • Three-quarters, or 73.6 percent, of pediatric dentists worked in practices that provided charitable dental care either free of charge or at a reduced rate to some patients in 2011.
  • Virtually 100 percent treat children with special needs, indicating that they are the default caretakers of dental care for all patients with special health care needs.
  • 60 percent of survey respondents report using an operating room and general anesthesia in a hospital or accredited surgical facility.
  • a third of pediatric dentists have the facilities, ability and willingness to easily expand services.

Read the full survey report.


The Use of Case Management to Improve Dental Health in High Risk Populations

The AAPD Pediatric Research and Policy Center is pleased to announce the publication of its most recent informational brief.  The brief addresses the topic of case management and how it can improve dental health in high-risk populations.

The combination of patient and provider barriers leads to low utilization of dental care options by publically insured pediatric patients, higher dental disease rates and treatment costs. Only by overcoming barriers to care will these children receive cost-effective preventive as well as therapeutic care.   Barriers to care can be breached by case management, which is a collaborative process of assessment, planning, facilitation, care coordination, valuation and advocacy for options, that has been shown to be a cost-effective tool to increase dental health in the publically insured population. Motivational interviewing (MI), a key component of case management, has proved to be effective in improving not only dental outcomes, but health outcomes in any population; when used in conjunction with other services (fluoride, xylitol, and/or treatment of disease) MI has been found to reduce cavity prevalence.  Ideally, use of case management leads to the patient adoption of a dental home. A dental home is a primary dental care provider that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.

Read the full report.


Resources

The UNC Chapel Hill School of Dentistry’s new website on Prenatal Oral Health (pOHP).  The main goal of pOHP� is to improve the health of every woman, fetus and child by engaging health care providers to deliver essential preventive oral health services during pregnancy. The website includes information for parents as well as videos for the dental team and primary care providers.


The Impact of Increased Medicaid Reimbursement in Connecticut

In Connecticut, similar to many other states, children on Medicaid could not easily access dental health services. Few dentists participated in the program with many providers citing low reimbursement rates and cumbersome program administration. Based on a 2008 lawsuit settlement agreement, program administration improved and reimbursement rates increased, moving closer to private insurance rates. In a project funded by the Connecticut Health Foundation, Drs. Douglass, Beazoglou and Bailit from the University of Connecticut examined Medicaid data between 2006 and 2011. The goal was to determine the effect of the increased Medicaid reimbursement on access to care and provider participation. 

The findings are very encouraging and show strong increased participation by private providers and a resulting increase in care for children on Medicaid. Specifically:

  • The number of children continuously enrolled in Medicaid with at least one visit grew from 46 percent in 2006 to 69.5 percent in 2011
  • In 2006 few private practitioners participated in Medicaid, while in 2011 approximately 50 percent of all active private general and pediatric practitioners were participating in the program.

Click here to read the full report.

 

Workforce Issues

New Zealand Government Reports

New Zealand is often touted as an example of how alternative dental providers may impact access to dental services and, ultimately the oral health of children at higher risk of dental disease. The POHRPC has compiled reports published or commissioned by the government of New Zealand that summarize the findings of a national review of the system, detailed information about child oral health inequalities, factors that contribute to these inequalities and recommendations to alleviate these inequalities, and discuss challenges and costs of such a system.

Click here to access these government reports.


State Dental Periodicity Schedules

Early and periodic screening, diagnostic and treatment (EPSDT) services are required services under the Medicaid program for most individuals under age 21. EPSDT is defined in section 1905(r) of the Social Security Act (the Act) and includes periodic screening, vision, dental, and hearing services and other necessary health services. Schedules specifying the content and periodicity of these services are to be established by each state after consultation with recognized medical organizations involved in child health care (in the case of screening, vision and hearing services) and dental organizations (in the case of dental services).

The Policy Center has compiled the Dental Periodicity Schedules for all states that have them. Click here to view the interactive map.


Second Opinion: Gorillas in the Dental Operatory

POHRPC Director Dr. Paul Casamassimo was recently provided a second opinion piece that appeared on Dr.Bicuspid.com. The article addresses ongoing financial and cultural challenges associated with Medicaid as it relates to the implementation of the Affordable Care Act.

According to Casamassimo, "Often, criticism is exchanged between the dental profession and child advocates about Medicaid reimbursement and dentists' willingness to care for Medicaid-supported children at reimbursements well below their typical fee. However, the reality of the inadequacy of Medicaid reimbursement as it relates to safety net dental programs caring for the poor brings this inequity into clearer focus. Today, across the U.S., safety net dental programs are failing or at risk because the cost of providing dental care has increased while Medicaid reimbursement has not."

Click here to read the article.


NCHS Data Brief - August 2012

In August, 2012, U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics released a new data brief entitled "Oral Health Disparities as Determined by Selected Healthy People 2020 Oral Health Objectives for the United States, 2009–2010." Click here for the full brief.

See also: NCHS Data Brief - No. 96 - May 2012 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics "Selected Oral Health Indicators in the United States, 2005–2008."


The National Dental PBRN is now Enrolling new Practitioners

pbrnlogoThe national network is a consortium of practices and clinics devoted principally to the oral health care of patients, but whose members investigate research questions with practical impact that will improve the quality of dental care. 

The goals are to conduct national oral health studies on topics of importance to practitioners and their patients, to provide evidence to improve routine dental care, and to facilitate movement of the latest evidence into routine clinical practice.  A key objective is to conduct studies that will improve the knowledge base for clinical decision-making.

 

Click here to download an informational brochure on the National Dental Practice-Based Research Network.


AAPD Testifies at FDA Amalgam Hearing

At the ADA's request, the AAPD submitted both written comments for the record and testified in person at hearings on dental amalgam conducted by the Food and Drug Administration's (FDA) dental products panel on Dec. 14-15, 2010, in Gaithersburg, Md. AAPD President John R. Liu presented the testimony, for which dental groups like the AAPD were only allotted four minutes while the anti-amalgam groups (who petitioned the FDA for reconsidered of its 2009 final regulation that amalgam was safe) were given much more time and latitude.

FDA Hearing - AAPD Oral Statement
FDA Hearing - AAPD Comments for Docket

The FDA panels did support the 2009 ruling, while recommending additional research. This is not surprising, because despite the presence of knowledgeable dentists on the FDA panel, including pediatric dentist Norman R. Tinanoff (chair of pediatric dentistry at the University of Maryland Baltimore College of Dental Surgery), some non-dentists members of the panel had clear and vocal sympathy for the anti-amalgam arguments. The ADA stated that: "The Association commended an advisory panel’s call for continued research while offering support for the Food and Drug Administration’s current amalgam regulation.The panel found that FDA acted appropriately in ruling last year that dental amalgam is a safe and effective treatment option for the general population." The full ADA statement is available at: http://www.ada.org/5145.aspx.


Dental Town Second Opinion

A Two Tier Standard: Dr. Rhea Haugseth argues against having a two-tiered standard of care for our nation's most vulnerable children.

Dental Town Second Opinion Article


WebMD Article on Bisphenol A Research

AAPD Pediatric Oral Health Research and Policy Center Director, Dr. Paul Casamassimo responds to research on bisphenol A by underscoring the need for additional research. According to Dr. Casamassimo, "More research is needed. We need to be constantly vigilant with kids and look at what we do and find out if these are valid findings over the long term," Follow the link for the full WebMD aticle.

Click here for the full article.


Related Information

 

Policy Center Advisory Board

Expanded Function Dental Assistant Toolkit

Selected Oral Health Indicators in the United States, 2005–2008


Contact Information

For additional information contact the Center's Assistant Director Jan Silverman at POHRPC@aapd.org.