- Email: [email protected]
Access to Medicaid dentists
THE BIG PICTURE Dental Implants Implants and aging Background.—Endosseous implants have demonstrated survival rates much greater than was originally expected, with some in place for 30 years or longer. The environment in which they are placed, however, changes as time passes, which raises questions about how to manage them as patients age.
low-retention magnets as the patient’s autonomy diminishes. Frail elders can be profoundly distressed if their appliance is too retentive, and this flexibility is much more desirable than maximum retention.
Aging Changes.—With aging, patients suffer diminished vision, tactile sensitivity, and dexterity, making it more difficult to handle dentures and perform adequate oral hygiene. Patients may also become frail and suffer multiple comorbid conditions, which can lead to dependency in performing activities of daily living. Tooth loss is also common, which can necessitate additional restorative treatment and a reconsideration of priorities.
Clinical Significance.—Dentists who wish to serve their patients throughout their lifetime must acknowledge the likelihood that those patients will suffer functional declines and design their treatment accordingly. Fixed and removable implant reconstructions that can be downgraded with little change in shape, vertical height, occlusion, and appearance can provide the support the patient requires without the fuss of a complex implant design. Computeraided design/computer-assisted manufacture (CAD/CAM) can facilitate the process, providing a simplified version of the dental prosthesis at a moderate cost and without requiring a traditional impression. Some patients will limit denture wearing or even refrain from wearing them altogether. Dentists need to be flexible, provide close monitoring as patients age, and institute ‘‘desophistication’’ as appropriate so that patients will see optimal benefits from modern implant dentistry.
Successful Implants.—The criteria for successful implant therapy include no persistent subjective complaints; no recurrent peri-implant infection with suppuration, mobility, or radiolucency around the implant; and the possibility of restoration. With a frail, dependent patient, these criteria should be joined by autonomy in managing a dental prosthesis. Dental prostheses for aging patients should be planned to allow them to be successfully managed by the patient with a diminished capacity, whether physical or otherwise. Therefore a successful implant should be sustainable but modifiable and adaptable to future needs. The Way Forward.—Rather than a highly sophisticated dental restoration that requires careful maintenance, dentists may serve their aging patients more appropriately by providing a more straightforward, manageable solution. Fixed implant reconstructions should be designed to serve as overdentures in the future, initially retained by a bar, then a stud or ball attachment, and finally by
M€ uller F, Schimmel M: Revised success criteria: A vision to meet frailty and dependency in implant patients. Int J Oral Maxillofac Implants 31:15, 2016 Reprints not available
Medicaid Access to Medicaid dentists Background.—The percentage of children enrolled in Medicaid who have visited a dentist in the past 12 months has risen from 29% in 2000 to 48% in 2013. As a result,
238
Dental Abstracts
the gap between those who are privately insured and those on Medicaid who visit a dentist has been narrowing. In addition, this is happening when more children are enrolled in
Medicaid and the Children’s Health Insurance Program, so more children are using dental benefits than in the past. The increase is the result of several factors, including reforms in Medicaid dental programs, policy reforms, innovations, and the actions of the dental workforce with respect to Medicaid. The role of dental practitioners in relation to Medicaid was evaluated. Dentist Workforce.—Although more children are enrolled in Medicaid and visiting dentists, the dentist supply has not greatly increased. Some dental practices have changed structure, with more large group practices and an expansion of Federally Qualified Health Centers. The effect of these new types of providers for dental care remains to be determined. Dentist participation in Medicaid was about 42% in 2014. A compilation of data from multiple sources on dental care use, sealant rates, access to fluoridated water, private dental benefit plan reimbursement, and number of dentists participating in Medicaid has indicated that the percentage of children enrolled in Medicaid who visit a dentist varies significantly between states that have the same numbers of dentists. For example, in Texas and Wisconsin the same number of dentists participate in Medicaid but dental care use among children enrolled in Medicaid is over twice as much in Texas as in Wisconsin. Also, children enrolled in Medicaid in Georgia and Utah visit the dentist at similar rates but Utah has 6 times the number of Medicaidparticipant dentists than Georgia. Analysis of the situation reveals that no specific number of providers participating in Medicaid is required to reach a benchmark of access and use. Therefore policymakers should focus on issues other than number of Medicaid dental care providers when considering ways to improve access to dental care for Medicaid-enrolled children. Reasons for these findings include limitations on the data used, a lack of correlation between geography and dental provider distribution, and ignoring patient factors that often determine dental care use. The last reason includes perceived need, convenience, patient engagement, and patient preferences and behaviors.
Factors to Consider.—When it comes to making policy decisions, performing research, or seeking better health care solutions, the key players should consider three major areas, including the extent to which there are sufficient numbers of dentists participating in Medicaid with a reasonable travel time from the beneficiaries, acceptance of new patients, and offering convenient appointment times. All three of these should be considered in future data and research. Second, policy interventions that target patient behavior, or the demand side of dental care use, should be the focus of efforts to understand dental benefit use patterns. These include direct-to-beneficiary outreach efforts, patient services (including community dental health coordinators), and user-friendly tools that help patients on Medicaid make appointments. Adults on Medicaid will especially benefit from these tools because they have challenges in accessing dental care that exceed those of children.
Clinical Significance.—Dentists who accept Medicaid should be aware of the factors that will help children and adults make appointments and use their dental benefits appropriately. Navigating the system can be a challenge, and any effort the dental staff can make to ensure dental care is delivered in a timely and readily available fashion will improve the dental health of all the individuals involved. It’s not numbers of dentists, but their availability and accessibility that will lead to greater numbers of Medicaidcovered patients coming to visit the dental office.
Vujicic M: Is the number of Medicaid providers really that important? J Am Dent Assoc 147:221-223, 2016 Reprints available from M Vujicic; e-mail: [email protected]
Oral Cancer Role of dental and general health practitioners Background.—Over 6500 people are newly diagnosed with oral cancer each year in the United Kingdom. Worldwide, oral/pharyngeal cancer is the sixth most common cancer seen. Survival is poor, perhaps because patients tend to
be diagnosed when their disease is at an advanced stage rather than early on. As a result, earlier detection is the goal, especially since most oral cancers are preceded by clinically evident lesions that could facilitate early diagnosis.
Volume 61
Issue 5
2016
239
low-retention magnets as the patient’s autonomy diminishes. Frail elders can be profoundly distressed if their appliance is too retentive, and this flexibility is much more desirable than maximum retention.
Aging Changes.—With aging, patients suffer diminished vision, tactile sensitivity, and dexterity, making it more difficult to handle dentures and perform adequate oral hygiene. Patients may also become frail and suffer multiple comorbid conditions, which can lead to dependency in performing activities of daily living. Tooth loss is also common, which can necessitate additional restorative treatment and a reconsideration of priorities.
Clinical Significance.—Dentists who wish to serve their patients throughout their lifetime must acknowledge the likelihood that those patients will suffer functional declines and design their treatment accordingly. Fixed and removable implant reconstructions that can be downgraded with little change in shape, vertical height, occlusion, and appearance can provide the support the patient requires without the fuss of a complex implant design. Computeraided design/computer-assisted manufacture (CAD/CAM) can facilitate the process, providing a simplified version of the dental prosthesis at a moderate cost and without requiring a traditional impression. Some patients will limit denture wearing or even refrain from wearing them altogether. Dentists need to be flexible, provide close monitoring as patients age, and institute ‘‘desophistication’’ as appropriate so that patients will see optimal benefits from modern implant dentistry.
Successful Implants.—The criteria for successful implant therapy include no persistent subjective complaints; no recurrent peri-implant infection with suppuration, mobility, or radiolucency around the implant; and the possibility of restoration. With a frail, dependent patient, these criteria should be joined by autonomy in managing a dental prosthesis. Dental prostheses for aging patients should be planned to allow them to be successfully managed by the patient with a diminished capacity, whether physical or otherwise. Therefore a successful implant should be sustainable but modifiable and adaptable to future needs. The Way Forward.—Rather than a highly sophisticated dental restoration that requires careful maintenance, dentists may serve their aging patients more appropriately by providing a more straightforward, manageable solution. Fixed implant reconstructions should be designed to serve as overdentures in the future, initially retained by a bar, then a stud or ball attachment, and finally by
M€ uller F, Schimmel M: Revised success criteria: A vision to meet frailty and dependency in implant patients. Int J Oral Maxillofac Implants 31:15, 2016 Reprints not available
Medicaid Access to Medicaid dentists Background.—The percentage of children enrolled in Medicaid who have visited a dentist in the past 12 months has risen from 29% in 2000 to 48% in 2013. As a result,
238
Dental Abstracts
the gap between those who are privately insured and those on Medicaid who visit a dentist has been narrowing. In addition, this is happening when more children are enrolled in
Medicaid and the Children’s Health Insurance Program, so more children are using dental benefits than in the past. The increase is the result of several factors, including reforms in Medicaid dental programs, policy reforms, innovations, and the actions of the dental workforce with respect to Medicaid. The role of dental practitioners in relation to Medicaid was evaluated. Dentist Workforce.—Although more children are enrolled in Medicaid and visiting dentists, the dentist supply has not greatly increased. Some dental practices have changed structure, with more large group practices and an expansion of Federally Qualified Health Centers. The effect of these new types of providers for dental care remains to be determined. Dentist participation in Medicaid was about 42% in 2014. A compilation of data from multiple sources on dental care use, sealant rates, access to fluoridated water, private dental benefit plan reimbursement, and number of dentists participating in Medicaid has indicated that the percentage of children enrolled in Medicaid who visit a dentist varies significantly between states that have the same numbers of dentists. For example, in Texas and Wisconsin the same number of dentists participate in Medicaid but dental care use among children enrolled in Medicaid is over twice as much in Texas as in Wisconsin. Also, children enrolled in Medicaid in Georgia and Utah visit the dentist at similar rates but Utah has 6 times the number of Medicaidparticipant dentists than Georgia. Analysis of the situation reveals that no specific number of providers participating in Medicaid is required to reach a benchmark of access and use. Therefore policymakers should focus on issues other than number of Medicaid dental care providers when considering ways to improve access to dental care for Medicaid-enrolled children. Reasons for these findings include limitations on the data used, a lack of correlation between geography and dental provider distribution, and ignoring patient factors that often determine dental care use. The last reason includes perceived need, convenience, patient engagement, and patient preferences and behaviors.
Factors to Consider.—When it comes to making policy decisions, performing research, or seeking better health care solutions, the key players should consider three major areas, including the extent to which there are sufficient numbers of dentists participating in Medicaid with a reasonable travel time from the beneficiaries, acceptance of new patients, and offering convenient appointment times. All three of these should be considered in future data and research. Second, policy interventions that target patient behavior, or the demand side of dental care use, should be the focus of efforts to understand dental benefit use patterns. These include direct-to-beneficiary outreach efforts, patient services (including community dental health coordinators), and user-friendly tools that help patients on Medicaid make appointments. Adults on Medicaid will especially benefit from these tools because they have challenges in accessing dental care that exceed those of children.
Clinical Significance.—Dentists who accept Medicaid should be aware of the factors that will help children and adults make appointments and use their dental benefits appropriately. Navigating the system can be a challenge, and any effort the dental staff can make to ensure dental care is delivered in a timely and readily available fashion will improve the dental health of all the individuals involved. It’s not numbers of dentists, but their availability and accessibility that will lead to greater numbers of Medicaidcovered patients coming to visit the dental office.
Vujicic M: Is the number of Medicaid providers really that important? J Am Dent Assoc 147:221-223, 2016 Reprints available from M Vujicic; e-mail: [email protected]
Oral Cancer Role of dental and general health practitioners Background.—Over 6500 people are newly diagnosed with oral cancer each year in the United Kingdom. Worldwide, oral/pharyngeal cancer is the sixth most common cancer seen. Survival is poor, perhaps because patients tend to
be diagnosed when their disease is at an advanced stage rather than early on. As a result, earlier detection is the goal, especially since most oral cancers are preceded by clinically evident lesions that could facilitate early diagnosis.
Volume 61
Issue 5
2016
239