❤❤❤ Dental Care Scenarios
Handling Medical Emergencies In The Dental Office - gretel2022.ns02.info
According to the results of the sixth census in , the total population aged 12 to 15 years and over 18 years in 31 provinces was 1. To explore the impact of the increase in the consumption of SFG, the study designed three different forms for analysis:. The first scenario individually evaluated each person in the model population apart from the individuals currently not using SFG using one more piece of SFG per day. The third scenario simulated increased SFG use for the entire model population to three pieces a day.
To evaluate the reliability of the results, estimates of important parameters in the model were changed, including the price 0. Table 1 shows the present situation regarding chewing SFG and corresponding caries prevalence among adolescents aged 12 to 15 years and adults aged 18 years and older in China. According to the results of different SFG chewing frequencies of the respondents, more than half of the survey population do not have the habit of using SFG.
The proportion of people who used SFG heavily was only 3. In general, as the chewing frequency of SFG increased, the corresponding population proportion gradually decreased, as did DMFT incidence. Table 2 presents the cost of dental care in different cities over the past 12 months. Nationwide, the expenditure due to caries per tooth was RMB Table 3 displays the potential cost savings under three different scenarios. With the increase in PCC, the average cost savings per person could range from Nationally, the 1.
Scenario 1 The consumption of SFG increased by 1 piece per day among the model population apart from the individuals currently not using SFG. Scenario 2 The consumption of SFG increased to 2 pieces per day among the model population. Scenario 3 The consumption of SFG increased to 3 pieces per day among the model population. Sensitivity analysis showed that when the important parameters mentioned in the Methods were all set at the minimum values, the average annual cost saving per capita was 3.
Table 4 When these parameters were the maximum values, the average annual cost savings per capita was Table 5. This study is the first to use cross-sectional survey data to analyze the potential economic benefits of SFG in caries prevention. The cross-sectional survey was aimed at providing real world data in China to simulate the dose—response relationship between chewing SFG and DMFT for the economic analysis purpose. Then, the dose—response assumption made by modeling real word data were used to explore the economic benefits of increasing the use of SFG in China.
A large number of studies have shown that chewing SFG can prevent the development of dental caries [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. We can therefore assume that an increased SFG consumption could greatly reduce dental care costs due to a potentially reduction of to dental caries. If Chinese adolescents aged 12—15 years and adults aged 18 years and older increased their current frequency of SFG use to 2 pieces per day, it might save The current health economic analysis on the use of SFG to prevent caries is very limited worldwide [ 18 , 19 , 20 ]. In a study conducted by Claxton et al. After increasing the annual per capita consumption of SFG from to in Germany, the annual cost savings per person was approximately In Reinhard et al.
The difference in annual cost savings per capita may be mainly due to differences in the cost of caries treatment in different countries. It can be estimated based on the basic national conditions that China has a total population of approximately 1. Thus, the potential and effect of cost savings from increasing the use of SFG far exceeds those of other countries. A number of studies have demonstrated the existence of a dose response relationship, that is, the more gum was chewed, the lower the rates of decay. Two studies on the effect of chewing SFG on the development of dental caries in Chinese residents showed that chewing two to four pieces of gum daily resulted in a reduction in DMFT increment ranging from Previous study on SFG economic evaluations globally used existing clinical study results as the relationship assumptions between SFG use and caries reductions.
In our study, the relationship between the annual consumption of SFG and DMFT was assumed based on the data we collected from a cross-sectional survey, the survey result was also consistent with those of previous clinical trials conducted in China. Size, taste and type streaks, pieces of sugar-free gum were not considered in this study. There is no evidence of a difference between the effects of commonly used sugar substitutes xylitol and sorbitol [ 33 ], 34 nor is there any data on the effects of other chewing gum properties.
Our study included only the national population with SFG chewing habits in the model. Therefore, the actual use of SFG in China significantly affects the research results. According to the study of Jing et al. According to Reinhard et al. Therefore, based on our scenario and population, chewing SFG would be suggested among the public, which may lead to an increase in the rate of SFG use in China and, consequently, a substantial reduction in dental health care expenditures.
In this study, only the cost of restoration was used to replace the cost of caries treatment. There were a mix of teenagers and adults in the study and restorations would be the common denominator as it is unlikely to have crowns, bridges and implants in teenager population although possible in adult population. In fact, the cost of caries-related root canal treatment, crown and bridge restoration, tooth extraction, and dental implant treatment is much higher than the cost of restoration in adult population. Therefore, our results actually underestimate the cost savings and long-term health benefits associated with increased SFG use. Therefore, by increasing SFG use and thus reducing the level of decay development, it is likely that greater long-term savings will be realized than the estimated amounts determined in this analysis.
SFG consumption may vary in different age groups and the process of urbanization. According to previous studies, teenagers and young adults are major consumers of SFG [ 36 ]. They might have open and independent consumption attitudes and tending towards consumption ideas of individuation and fashion. Also, they are often willing to try something new. The reason why they buy and chew sugar-free gum may be not necessarily to prevent dental caries, but to freshen their breath. As for urbanization, there are few studies onto it.
Base on one study among army men and cadets in China [ 37 ], the chewing rate in urban areas was similar to that in rural areas. There are also studies in China suggesting that there were limited resources of SFG in rural areas [ 37 , 38 ]. It may affect the consumption of SFG in rural areas. There are some limitations in our study. First, because only the cost of caries restoration was used to represent the treatment cost due to caries and only the potential cost savings that may occur due to the occurrence of dental caries in a relatively short 1 year period are obtained, the result is likely to underestimate the lifetime possibility cost savings and long-term health benefits. Besides, although the dose—response relationship between SFG annual consumption and DMFT in our study was assumed on the basis of cross-sectional data, we found it is consistent with the results obtained from previous clinical trials conducted in China.
Future research should focus on increasing the sample size to allow the benefits of chewing gum to be distinguished among different age groups, and well-designed clinical trials should be designed to evaluate the effect of SFG on dental caries. This study suggests that substantial cost savings could be achieved if SFG use levels were increased in the Chinese population. Though there is no doubt that regular and effective brushing and flossing are still the main measures of dental health, chewing SFG regularly could be considered as an aid to teeth cleaning.
The datasets used during the current study are available from the corresponding authors on reasonable request. Global burden of oral conditions in — a systematic analysis. J Dent Res. Article Google Scholar. Petersen PE. Coinmimity Dent Oral Epidemiol. Global economic impact of dental diseases. Utilisation of oral health services and economic burden of oral diseases in China. Chin J Dent Res. PubMed Google Scholar. Oral health status and oral health care model in China.
Fluoride revolution and dental caries-evolution of policies for global use. EFSA Journal , 8 10 A systematic review and meta-analysis of the role of sugar-free chewing gum in dental caries. Sugar-free chewing gum and dental caries-a systematic review. J Appl Oral Sci. Biological factors in dental caries enamel structure and the caries process in the dynamic process of demineralization and remineralization part 2. J Pediatr Dentistry. Google Scholar. Effect of casein phosphopeptide-amorphous calcium phosphate containing chewing gum on salivary concentration of calcium and phosphorus: an in-vivo study.
Abdul P, Saheer, Preetika, Parmar: Effect of sugar-free chewing gum on plaque and gingivitis among 14—year-old school children: A randomized controlled trial. Indian journal of dental research:official publication of Indian Society for Dental Research Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. Cost-effectiveness Analysis of comprehensive oral health care for severe early childhood caries in urban Beijing, China. Rudmik L, Drummond M. Health economic evaluation: important principles and methodology. Br Dent J. Elevating the use of sugar-free chewing gum in Germany: cost saving and caries prevention.
Acta Odontol Scand. A global approach to assess the economic benefits of increased consumption of sugar-free chewing gum. Am J Dent. Geneva , World Health Organization. National Bureau of Statistics Alamoudi NM, HannoA. The Journal of Pediatric Dentistry , 37 2 — Xylitol candies in caries prevention results of a field study in Estonian children. Community Dent Oral Epidemiol. The effect of chewing sugar-free gum after meals on clinical caries incidence. J Am Dent Assoc. Burt BA. The use of sorbitol- and xylitolsweetened chewing gum in caries control.
J Am Dental Assoc. Six months of high-dose xylitol in high-risk caries subjects—a 2-year randomised, clinical trial. Clin Oral Investig. Deshpande A, Jadad AR. The impact of polyol-containing chewing gums on dental caries: a systematic review of original randomized controlled trials and observational studies. A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents. Int J Paediatr Dent. Caries preventive effect of sugar-substituted chewing gum. Can school-based oral health education and a sugar-free chewing gum program improve oral health?
Results from a two-year study in PR China. A randomized trial on the inhibitory effect of chewing gum containing tea polyphenol on caries. It is not possible to calculate a correct estimate for that year due to the MCBS data collection issue. CMS resolved this issue in Due to this and other methodological changes in our analysis, estimates of the number of people on Medicare with dental insurance cannot be trended using our estimate. Please see the methodology here for more information. Oral health is an integral part of overall health, but its importance to overall health and well-being often goes unrecognized. Having no natural teeth can cause nutritional deficiencies and related health problems.
Medicare, the national health insurance program for about 60 million older adults and younger beneficiaries with disabilities , does not cover routine dental care, and the majority of people on Medicare have no dental coverage at all. Limited or no dental insurance coverage can result in relatively high out-of-pocket costs for some and foregone oral health care for others. This brief reviews the state of oral health for people on Medicare. It describes the consequences of foregoing dental care, current sources of dental coverage, use of dental services, and related out-of-pocket spending. Figure 1: Most people on Medicare do not have dental coverage, and many go without needed care. Numerous studies confirm the direct connection between oral health and overall health.
Periodontal disease, or advanced gum disease, is associated with increased risk of cardiovascular diseases, including arteriosclerosis, coronary heart disease, and stroke, 10 , 11 , 12 increased risk of mortality for those with chronic kidney disease, 13 adverse pregnancy outcomes, 14 increased risk of cancer, 15 , 16 and poor glycemic control for diabetes. For example, inflammation and dysbiosis may generate immune responses that increase the risk of cancer as well as contribute to insulin resistance that makes diabetes management more difficult. Oral health issues pose particular concerns for older adults.
For example, xerostomia dry mouth is a side effect for hundreds of medications. Dry mouth significantly increases the risk of dental caries, loosening dentures that can lead to painful ulcerations, difficulty chewing or swallowing and altered taste, which can negatively impact nutrition, as well as a series of other oral health issues such as recurrent oral thrush and lesions on the oral mucosa. Among adults 65 and older residing in the community, 15 percent are edentulous, meaning they have no natural teeth Figure 2. Edentulism is also more common among seniors with low incomes. While edentulism among all older adults has declined over time, the greatest declines have been among primarily high income populations.
For example, more than 30 percent of seniors in West Virginia have no natural teeth, compared to less than 10 percent in states such as California and Connecticut. Figure 2: 15 percent of adults ages 65 and older have no natural teeth. Having no or few teeth can adversely impact quality of life. Many older adults report being embarrassed about their teeth, avoid smiling, and even reduce social participation due the condition of their mouth and teeth. Among all Medicare beneficiaries living in the community, 18 percent have some difficulty chewing and eating solid foods due to their teeth — a rate that rises to 29 percent for those with low incomes and 33 percent for adults with disabilities on Medicare who are under age Poor oral health is associated with potentially preventable and costly emergency department ED visits, with more than 2 million visits to the ED each year among people of all ages due to oral health complications.
A relatively large share of people on Medicare go without needed dental care. The American Dental Association recommends at least one annual visit per year , but suggests more frequent visits depending on the health status and dental needs of individual patients. Figure 3: Nearly half of Medicare beneficiaries did not visit the dentist in the past year. Many Medicare beneficiaries go without dental care due to costs. Overall, 10 percent of all beneficiaries did not get needed dental care in the past year because they could not afford it Figure 4.
While cost is often cited as top reason for not going to the dentist among those who said they needed care but did not go, fear of the dentist, inconvenient location or time for an appointment are also important contributing factors. Figure 4: Medicare beneficiaries with low incomes, in poor health, and under age 65 with disabilities are most likely to go without needed dental care due to costs. Older adults also encounter additional challenges accessing oral health care, including dental health professional shortages, transportation challenges, and health literacy issues. Approximately 46 million people of all ages live in dental health professional shortage areas, 66 percent of which are considered rural. Medicare beneficiaries who used dental services may or may not have had dental insurance, including dental coverage through Medicare Advantage, Medicaid, or private plans.
As might be expected, average out-of-pocket spending on dental care rises with income because higher income beneficiaries are more able to afford such expenses, not because they have greater dental needs. Conversely, lower income beneficiaries are more likely to forego needed dental care. Since its establishment in , Medicare has explicitly excluded coverage for dental services , except in very limited circumstances. Figure 6: Medicare covers limited dental services. Medicare coverage is limited to dental services that are an integral part of a covered procedure, extractions done in preparation for radiation treatment for cancers involving the jaw, and oral examinations but not treatment preceding kidney transplants or heart valve replacements.
Beneficiaries without any form of dental coverage are more likely than others to go without needed dental care, unless they can afford to cover the costs out-of-pocket. Figure 7: Almost two-thirds of all people on Medicare have no dental coverage. The remaining Medicare beneficiaries have access to dental coverage through Medicare Advantage plans, Medicaid, and private plans, including employer-sponsored retiree plans and individually purchased plans. In , about An estimated 6. The scope of dental coverage and affordability of dental care is an issue for people of all ages.
Private dental insurance plans, primarily for working-age adults, vary in terms of benefits and cost-sharing, but typically provide limited coverage for high-cost treatments. Private dental insurance tends to cover most, if not all costs, associated with preventive services, but has less generous coverage for more expensive services, exposing patients to high out-of-pocket costs for needed dental care. In the following sections, we review current sources of dental coverage that may be available to people on Medicare, including Medicare Advantage, Medicaid, and private dental plans employer-sponsored retiree and individually purchased. Many Medicare Advantage plans provide access to dental coverage as a supplemental, non-Medicare covered benefit.
Figure 8: Most Medicare Advantage enrollees have access to coverage of some dental care through their plan. Additional Premiums for Dental Coverage. Some Medicare Advantage plans charge an additional premium for dental benefits, and enrollees must pay that premium in order to receive the dental coverage. No data are available about how many people take up this option when a premium is required.
Dental premiums are in addition to premiums for other Medicare Advantage benefits, as well as the Medicare Part B premium. Some plans require no cost-sharing for preventive services but charge a monthly premium, while other plans require enrollees to pay a flat co-pay e. Similarly, for relatively extensive benefits, some plans cover most of the cost of some benefits e. Annual Caps on Coverage and Service Limits. Medicare Advantage plans that offer access to preventive and more extensive dental benefits commonly cap the total amount the plan will pay for dental care.
In addition to dollar limits, Medicare Advantage plans typically limit the number of services covered e. In , approximately 10 million Medicare beneficiaries qualified for Medicaid, with 7 million qualifying as full dual eligibles and 3 million as partial dual eligibles. State Medicaid programs are not required to cover dental benefits for adults because it is an optional benefit, and can choose to provide the benefit to some but not all dual eligibles.All procedures Dental Care Scenarios performed tet offensive date Dental Care Scenarios with relevant guidelines. According Dental Care Scenarios their documentation, whenever HubSpot changes the session cookie, Dental Care Scenarios cookie Maos Failure Of The Great Leap Forward In China also Dental Care Scenarios to determine if the visitor has restarted their browser. Private dental insurance plans, primarily for working-age adults, vary in terms of benefits and cost-sharing, Dental Care Scenarios typically provide Dental Care Scenarios coverage Dental Care Scenarios high-cost treatments. Given Dental Care Scenarios significant health risks associated Dental Care Scenarios poor oral care and the costs and consequences of Dental Care Scenarios dental needs, identifying potential solutions to improve the Dental Care Scenarios health status Dental Care Scenarios the Dental Care Scenarios population remains a challenge.