DEVELOPMENT OF A DENTAL ACCESS SURVEY INSTRUMENT FOR CHILDREN WITH AUTISM SPECTRUM DISORDERSBy Roy H. Rogers, B.A., B.S., D.D.S.A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University.Virginia Commonwealth University, June 2003Thesis Director: Frank H. Farrington, D.D.S., M.S.Department of Pediatric DentistryPurpose: The purpose of this study was to develop a survey instrument or questionnaire to evaluate access to dental care for children with autism spectrum disorders.Methods: The research methods of this study were conducted in a 16-step process. Survey questions were evaluated based on analysis of response frequencies and item non-response (missing data), the content of open-ended responses on the questionnaire, the researcher's judgment regarding how well the question worked within the questionnaire design construct, redundancy across questions, and whether or not the question met the project's proposed analytical goal (purpose): to evaluate access to dental care for children with autism spectrum disorders. Judgment-based evaluation of each question was tabulated using Excel spreadsheet format.Results: The overall response rate for the pilot test mailing was 46.8% (22/47). The overall sample size was reduced from n=50 to n=47 due to one undeliverable survey instrument/questionnaire and two survey instrument/questionnaires returned because neither respondent had any children with autism spectrum disorders. The mean age of children sampled was 7.1 years with a standard deviation of 3.6 years. 68.2% (15/22) of the children were male and 31. 8% (7/22) were female. 22.7% (5/22) found it difficult to locate a dentist to treat their child. 54.5% (12/22) of children were treated by a pediatric dentist. 52.9% (9/17) required the use of restraints when being treated by a dentist. 52.4% (11/22) described their child's behavior as uncooperative requiring either nitrous oxide, oral sedatives, or general anesthesia in order to be treated. 81.8% (18/22) of respondents indicated that their child had some form of dental/medical health care coverage including but not limited to private health insurance. Survey questions 9, 10, 14, 15, 20, 25, and 51 were revised, questions 2, 4, 5, 28, and 38 were omitted, and one question was added (question number 4) in the final survey instrument.

The Muscatine Pediatric Dentistry Clinic (MPDC) at the Muscatine Center for Social Action (MCSA) was established January 4th, 2005. It is a partnership between the MCSA and The University of Iowa's Department of Pediatric Dentistry. MPDC operates Tuesdays (care provided by senior dental students) and Thursdays (care provided by pediatric dentistry residents). Students and residents are supervised by a pediatric dentistry faculty member. MPDC's mission is to provide dental care to low income children residing in Muscatine and Louisa counties, in Iowa. Care includes diagnostic, preventive, restorative, and emergency services. MPDC targets a population that has been traditionally underserved by local dentists including Medicaid-enrolled children and low income children without dental insurance. MPDC offers dental students the opportunity to gain experience treating children with the ultimate goal of increasing the number of practicing general dentists who serve pediatric populations. MPDC completed 6 years of operation on January 4th, 2010. The main goals of this study were to describe patient characteristics, clinical activities and parental satisfaction at the Muscatine clinic and to compare characteristics of the Muscatine clinic to those of the University of Iowa's pediatric dentistry clinic at the College of Dentistry. Clinical activities and patient profile variables for MPDC were reported for the entire fiscal year 2009-10 year. Variables include patient age, gender, type of insurance, number of dental procedures completed, type of treatment received, and number of visits per patient. A satisfaction survey was given to the parent of each patient presenting to the MPDC clinic between November 16th, 2009 and January 17th, 2010. Two broad research questions were addressed in this study: 1) Are parents satisfied with MPDC and the treatment provided to their children? 2) Are there are differences in the population served and treatment provided at the Muscatine clinic and the University of Iowa pediatric dentistry clinic at the College of Dentistry? The results of this study provide information that contributes to a fuller understanding about the population served by MPDC, the treatment received, and parental satisfaction with the clinic. It also compares characteristics of the Muscatine clinic to the University of Iowa's pediatric dentistry clinic at the College of Dentistry. The results of this study may help guide MPDC staff and the University of Iowa's Department of Pediatric Dentistry in future decision-making regarding clinic activities and dental school curriculum.

Objectives: To determine access to dental care among preschool children of Arabic-speaking immigrant families; to investigate the influence of social and cultural factors on access to dental care; and to measure preschool children’s oral health as reported by their parents. Methods: This survey used a semi-structured questionnaire to interview 100 Arabic-speaking parents of children under the age of 5 who were identified from community centres. Five scales were used to measure acculturation, social capital, oral health literacy, oral health knowledge, and health literacy. Results: Only 34% of families had visited the dentist to obtain dental care for their preschool children. Nineteen-percent of Arabic parents in our sample rated their children’s oral health as being fair or poor. None of the scales used in this study had a significant impact on access to dental care; however, higher scores on these scales tended to be associated with better access to dental care.

Objectives: To determine access to dental care among preschool children of Arabic-speaking immigrant families; to investigate the influence of social and cultural factors on access to dental care; and to measure preschool children’s oral health as reported by their parents. Methods: This survey used a semi-structured questionnaire to interview 100 Arabic-speaking parents of children under the age of 5 who were identified from community centres. Five scales were used to measure acculturation, social capital, oral health literacy, oral health knowledge, and health literacy. Results: Only 34% of families had visited the dentist to obtain dental care for their preschool children. Nineteen-percent of Arabic parents in our sample rated their children’s oral health as being fair or poor. None of the scales used in this study had a significant impact on access to dental care; however, higher scores on these scales tended to be associated with better access to dental care.

Even though the oral health of Americans has improved greatly in the last 50 years, some specific groups of the population have been left behind. Latinos, children and adults, bear a disproportionate burden of oral diseases. Latino children, the fastest growing minority group of children in the US, are affected disproportionately by oral diseases like dental caries compared to other groups. Understanding the difficulties and barriers that these children have to utilize dental care will help us in the future to develop effective programs to reduce health disparities in this segment of the population. The purpose of this study is to identify the factors that determine dental services access and utilization by children in the state of Iowa. Emphasis will be given to differences in utilization of dental services among different racial/ethnic groups. Additionally, the study will describe and compare difficulties in utilization of care among Latino children whose parents answered the survey in English (LE) and those who answered it in Spanish (LS). In order to address these objectives existing data from the Iowa Child and Family Household Health Survey 2005 (HHS) were analyzed. The dependent variable for the study was utilization of dental services. This outcome variable was dichotomized as whether or not the child had a dental visit in the last year. Characteristics of study subjects were first analyzed through descriptive statistics. Bivariate analyses were conducted to assess associations between the dependent variable and independent variables. Multiple logistic regression was used to identify factors associated with utilization of dental services in Iowa's children, and for each different racial and ethnic group. Seven factors were related to the time of the last dental visit for Iowa children: Having a regular source of dental care, dental insurance status, having a dental need in the past 12 months, brushing habits, the age of the children, and family income. The same seven factors were correlated to having a dental visit for white children. For African-American children, having a regular source of dental care, dental insurance status, and having a dental need in the last 12 months were the factors that were found associated to the time of the last dental check-up. For the Latino Spanish children, having a regular source of dental care and the age of the children were factors associated to dental utilization. Finally, for the Latino English children, the only factor associated with having a dental visit was having a regular source of dental care. Information from this research gives policy makers, public health workers, and clinicians an overview of oral health disparities affecting children in the state. For those agencies in Iowa interested in the improvement of access and utilization of dental services for minority children, this project gives important inside about the factors related to the use of services for different racial/ethnic groups in the state.

Avoidable use of the Emergency Departments (EDs) constitutes a significant public health problem, which has health, economic and ethical implications. The factors that affect avoidable use of the EDs are complex and poorly understood. The goal of this dissertation was to examine the role of medical home in avoidable pediatric ED visits, assess the impact of Medicaid policy on ED visits for dental problems and assess the factors affecting follow-up dental care after a dental ED visit. Iowa Household Health Survey data was used for the first study, which included a sample of families with at least one child residing in Iowa. It was found that 68% of parents who took their child to an ED in the previous year thought the ED visit could have been avoided if primary care was available to them. Having a medical home was not found to be associated with pediatric ED visits; however, food insecurity was significantly associated. Parents of children with public insurance, those who were not referred by a healthcare provider and those who reported difficulty in getting routine care appointments were more likely to report an avoidable ED visit by their child. The second study examined a policy change in California where Medicaid eliminated its comprehensive adult dental coverage on July 1, 2009. State Emergency Department Database were obtained from Agency for Healthcare Research and Quality for California for 2006 through 2011. Interrupted time series, a quasi-experimental approach of was used to examine the impact of the policy change on rate of dental ED visits by Medicaid enrolled adults. Segmented linear regression revealed that policy change led to an immediate significant increase in the rate of dental ED visits. The policy had a differential impact on various subgroups based on age, race-ethnicity and residential location. The annual costs associated with dental ED visits made by Medicaid adults also increase 68%. Survival analytic approach was used in the final study to examine the patterns of dental care following a dental ED visit by Medicaid enrolled adults in Iowa. Medicaid claims and enrollment data were used to identify adults with an index dental ED visit in 2011, and then each subject was followed for up to 6 months. About 52% of all adults who satisfied the study inclusion criteria, had a follow up dental visit within 6 months of the index dental ED visit. Cox regression model revealed that adults who had visited a dentist in the year prior to the ED visit had greater hazards of having an early dental follow up after the ED visit. Having repeated dental ED visits was found to have a dose-response relationship to follow-up time to dentist visit, with those having 1 repeat ED visit having 53% hazards and those with 2 or more repeat ED visits having 34% hazards of having a follow-up dentist visit, compared to those with no repeat ED visits. Collectively, the results from this dissertation provide important insights in understanding the complex problem of avoidable ED visits. Factors such as food insecurity and medical home need to be further investigated in their association with avoidable ED visits. State Medicaid policy plays an important role and limiting Medicaid adult dental coverage may lead to an increased reliance of the affected population on EDs for dental care. However, EDs do not provide any definitive dental care, and our results indicate that almost half of the adults with dental ED visit do not have a follow-up dentist visit in the next 6 months.

This research explores final year dental students’ knowledge and attitudes towards the treatment and management of patients with Intellectual and Developmental Disabilities (I/DD) as related to variations in the dental practices in Special Health Care Needs (SHCN) training they received. A quantitative, non-experimental study was conducted, employing survey data collection methods, to address descriptive, comparative, and correlational questions. One cohort, Class 2020, attended extramural rotations in specialized clinics for patients with I/DD and in-person lecture concerning this topic. However, due to the COVID-19 pandemic and its health-related restrictions, another cohort, Class 2021, did not have the same opportunity as rotations were cancelled and the lecture was prerecorded and viewed online. Responses from a 35-item survey, distributed through an online platform, were obtained from both cohorts (n= 14 for Class 2020; n= 19 for Class 2021), addressing descriptive, comparative, and correlational research questions. Results revealed higher levels of knowledge and more positive perceptions of the program from Class 2020, the group that received clinical guidance, than Class of 2021. Analysis revealed positive relationships between students’ confidence levels and whether they had examined, assisted, or treated patients with I/DD. Associations were also found between students’ confidence and willingness to treat patients with I/DD. Although only correlational, this study’s findings suggest ways to foster students’ confidence and induce positive attitudes in dental school graduates that are likely to improve equitable access to healthcare for those with I/DD.

Oral health is strongly correlated to systemic health in the United States. Dental professionals play a significant role in addressing the oral health and prevention of disease for populations in the United States. Because many areas in the United States lack access to dental care, the federal government considers dental hygienists part of the solution. It is now paying attention to restrictive dental hygiene scope of practice rules in each state. State dental boards, comprised mainly of dentists, make these rules based on their perception of dental hygienists' lack of education. This study explored fourth-year dental students' perceptions of the dental hygienist's education and scope of practice. This research found that while dental students felt that the dental hygienist would be a positive addition to their future practices, they did not wholly understand the rigors of dental hygiene education. In addition, dental schools may need to educate on the differences between direct and general supervision.