Reimbursing dentists for smoking cessation treatment: views from dental insurers.
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INTRODUCTION: Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers' role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers. METHODS: Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identified using a targeted sampling method and represented viewpoints from a significant share of companies within the dental insurance industry. RESULTS: All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage. CONCLUSIONS: Dissemination of findings on efficacy and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings. (+info)
Separating fact from fiction: use of high-level evidence from research syntheses to identify diseases and disorders associated with periodontal disease.
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Correlations with periodontitis have been reported for several diseases, although the biological mechanisms that might lead to these putative correlations are generally unclear. This paper describes the most robust of these associations, on the basis of an evaluation of research syntheses (meta-analyses and systematic reviews) available up to June 2011. This high-level evidence indicates that individuals with periodontitis have a significantly higher risk of various other problems, including cardiovascular disease, diabetes mellitus, respiratory disease and preterm low-birth-weight deliveries. For some conditions, treatment of periodontitis leads to a reduction in the rates of the other disease, lending further support to the concept that the association is reversible. An understanding of these correlations is important to allow dental health care providers to inform patients with periodontitis of their increased risks and to counsel such patients to seek additional medical assessment or intervention, as indicated. (+info)
Dental students and bloodborne pathogens: occupational exposures, knowledge, and attitudes.
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Dental professionals may be exposed to bloodborne pathogens in their work, and dental students may be a particularly vulnerable group. Fear of exposure has also been linked to discriminatory practices. A cross-sectional survey of dental students was conducted at one U.S. dental school to assess their knowledge about the transmission of bloodborne pathogens and management of exposures; the frequency of their bloodborne pathogen exposures (BBPEs); and associations among their prior exposure, knowledge, perception of knowledge, and attitudes toward practice. Overall, 220 students (72.1 percent) responded to the survey, and 215 (70.5 percent) answered questions about exposures. The prevalence of BBPE was 19.1 percent and was greater among clinical than preclinical students (p<0.01). Percutaneous injuries occurred in 87.5 percent of those exposed. All students (preclinical and clinical combined) answered more survey questions correctly about transmission of bloodborne pathogens (66.7 percent) than about post-exposure management (25.0 percent). Fewer than half reported adequate knowledge of transmission and management (47.5 percent and 37.3 percent, respectively). In this context, 8.2 percent of the respondents acknowledged an unwillingness to perform procedures on patients with HIV. Since knowledge gaps may lead to failure to report incidents and delays in appropriate exposure management and some negative attitudes towards treating individuals with HIV persist, these findings justify improving BBPE education at U.S. dental schools. (+info)
Rethinking tenure in dental education.
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In the midst of changes in the environment of academic dentistry over the past two decades, reform of traditional tenure is one way for dental schools to respond to these changes while maintaining scholarly, evidence-based learning environments. Challenges facing academic dentistry today and in the future include a crisis in workforce capacity, difficulty attracting recent graduates into academic positions, overburdened faculty members with limited time for scholarly activity, loss of tenured faculty members due to retirement, and a potentially diminished voice for dental schools within the parent university. The purpose of this opinion article is to suggest ways to reform the current tenure system in dental education as a means of improving recruitment and retention of new faculty members while maintaining or increasing scholarly activity within dental schools. (+info)
An online community of inquiry for reflective practice in an operative dentistry course.
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Online learning communities are entering the realm of web-based learning as a means of reflective collaborative learning. The purpose of this article is to describe the formation of an online learning community using a community of inquiry (COI) conceptual framework. Operative clinical simulation dental students at the University of British Columbia in Canada have been involved in an online COI for the past five years. This descriptive article presents an overview of the experiences involved in developing this COI and provides a conceptual framework for an online COI. (+info)
The PBRN initiative: transforming new technologies to improve patient care.
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The NIDCR-supported Practice-based Research Network initiative presents dentistry with an unprecedented opportunity by providing a pathway for modifying and advancing the profession. It encourages practitioner participation in the transfer of science into practice for the improvement of patient care. PBRNs vary in infrastructure and design, and sustaining themselves in the long term may involve clinical trial validation by regulatory agencies. This paper discusses the PBRN concept in general and uses the New York University College of Dentistry's Practitioners Engaged in Applied Research and Learning (PEARL) Network as a model to improve patient outcomes. The PEARL Network is structured to ensure generalizability of results, data integrity, and to provide an infrastructure in which scientists can address clinical practitioner research interests. PEARL evaluates new technologies, conducts comparative effectiveness research, participates in multidisciplinary clinical studies, helps evaluate alternative models of healthcare, educates and trains future clinical faculty for academic positions, expands continuing education to include "benchmarking" as a form of continuous feedback to practitioners, adds value to dental schools' educational programs, and collaborates with the oral health care and pharmaceutical industries and medical PBRNs to advance the dental profession and further the integration of dental research and practice into contemporary healthcare (NCT00867997, NCT01268605). (+info)
Translating research into everyday clinical practice: lessons learned from a USA dental practice-based research network.
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