Oral Health Epidemiology and Policy in Disadvantaged PopulationsKhouja, Tumader (2020) Oral Health Epidemiology and Policy in Disadvantaged Populations. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractThis dissertation seeks to study important questions regarding oral health epidemiology and policy affecting oral health care access and outcomes in disadvantaged populations. Chapter one introduces the research problems. Chapter two examines the association between dental policies for adults in Medicaid and children’s receipt of preventive dental services. Although prior research has found “spillover effect” between adults Medicaid coverage and children’s use of preventive medical visits, this relationship has not been studied in dentistry. We use 14 years of nationally representative survey data to link parents and their children and run two quasi-experimental analyses. We evaluate the effect of changes in dental benefits for adults in Medicaid and the effect of Medicaid expansions for adults under the Affordable Care Act on children’s use of preventive dental services. We find no evidence of a “spillover” effect between adult dental policies and children’s receipt of preventive dental services. Chapter three evaluates the problem of excess opioid prescribing for dental procedures. We evaluate the risk of an initial opioid fill and subsequent opioid fills based on the likelihood of pain associated with the dental procedure among opioid naïve PA Medicaid beneficiaries. Using Medicaid claims data from 2012-2017, we find that patients who filled an opioid for procedures with low likelihood of pain were more likely to use opioids in the short term compared to those who did not fill an opioid for the same procedures and compared to patients with an initial opioid for procedures with moderate and high likelihood of pain. This dissertation has important implications for public health. Our findings provide evidence for health system interventions to: 1) improve the integration of oral health with systemic health for patients with type 1 diabetes. 2) The need for policy interventions that have a more direct impact on improving low-income children’s use of preventive dental services. 3) Emphasizing NSAID as a first line of therapy for management of dental pain and re-evaluating the current guidelines for opioid prescribing in the dental practice. Share
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