Thesis
A study of provided services, oral health knowledge, and referral practices of non-dental health care professionals at federally qualified health centers in regard to recognition, prevention and treatment of early childhood caries
University of Iowa
Master of Science (MS), University of Iowa
Summer 2025
DOI: 10.25820/etd.008126
Abstract
Objective: The purpose of this research was to examine the oral health services (OHS) provided, oral health knowledge, and referral practices of non-dental health care professionals at federally qualified health centers (FQHCs) in relation to the recognition, prevention, and treatment of early childhood caries (ECC).
Methods: This cross-sectional study was conducted with nondental healthcare providers at FQHCs nationwide who treat children ages 0 – 5 years old. A 62-item online survey was developed and then disseminated after IRB approval through organizational newsletters and FQHC websites. Respondents reported on their provision of six OHS, confidence in four OHS, oral health training, and referral practices. OHS scores were calculated for each respondent and categorized as “few” for those providing 0 – 4 OHS vs. “many” for those providing 5 – 6 OHS. Confidence in providing OHS was categorized as “more confident” vs. “less confident.” Bivariate and multivariable analyses were used to identify variables associated with providing many OHS and having more confidence in delivering OHS.
Results: Eighty non-dental healthcare providers completed the survey. The majority of respondents had oral health training in their professional school education programs. The average age of respondents was 46.7 years, and the average number of years since graduating with the highest degree was approximately 19 years. When examining each OHS individually, over 50 percent of respondents reported delivering each of the following five OHS: referring to dentists (84%), providing dietary counseling regarding prevention of oral health issues (73%), providing education to parents regarding preventive dental care for children (70%), inquiring about a child’s dental home (69%), and evaluating teeth during routine exams (59%). Examined together, approximately 57% of respondents provided “many” OHS. Additionally, more than 50 percent of respondents reported being confident providing three out of four OHS: providing nutritional guidance pertaining to oral health (74%), advising parents about their child’s oral care (70%), and identifying tooth decay in a child (54%). Additionally, approximately 40% of respondents reported overall “more” confidence providing OHS. Fluoride varnish application was the service provided least frequently with 36% of respondents applying varnish. Applying varnish was also the service associated with the lowest confidence levels with 38% of respondents expressing confidence providing the service. Most respondents who did not apply fluoride varnish cited scope of practice limitations; those who did apply varnish typically reported that it was required by their employer.
Provider clinical role emerged as the most significant variable associated with both OHS provision and OHS confidence: professionals who were Assistant/Associate Physicians, Nurse Practitioners, Physician Associates/Assistants and Family Medicine/ Practice Physicians, Pediatricians, and Residents were significantly more likely to perform and feel confident in delivering OHS compared to respondents who were Medical Assistants/Nursing Assistants and Registered Nurses / Licensed Practical Nurses. Having oral health training during professional school was associated with greater provision of certain services, but training did not significantly affect provider confidence. Logistic regression analyses showed that primary clinical role, increased confidence providing OHS, and treating a patient population composed of >50% pediatric patients with Medicaid was associated with providing “many” OHS. Variables associated with expressing “more” confidence providing oral health services after multivariable analyses were primary clinical role, treating ≥25% pediatric patients ages 0 – 5 years old, and knowledge of state-level fluoride varnish guidelines. While general oral health knowledge was high, knowledge of certain topics — particularly knowledge regarding the recommended age for the first dental visit and use of fluoridated toothpaste — was lacking. The majority of respondents referred pediatric patients to dentists, most often within their own organization, and mostly on a voluntary basis.
Conclusions: The study highlights the important role of provider clinical role, oral health training, and patient demographics, in the delivery of oral health services. Primary clinical role emerged as the most significant variable associated with both the provision of and confidence in delivering oral health services among non-dental healthcare professionals. These differences may stem from variations in education, clinical training, scope of practice, and professional duties. Although oral health training during professional school was linked to a higher provision of certain services, it did not significantly influence confidence. Unfamiliarity with certain oral health knowledge topics may indicate the need for more targeted efforts of information dissemination. Despite the small sample size, this study makes an important contribution to the literature as one of the first to be conducted specifically within FQHCs. By focusing on providers who treat children aged 0–5 and including multiple primary care disciplines, the study offers a more comprehensive view of oral health integration in safety-net settings. Future research should aim to include larger, more diverse samples of non-dental healthcare providers across more geographic regions. Future studies should also use tailored survey instruments that account for different provider roles and state-specific regulations.
Details
- Title: Subtitle
- A study of provided services, oral health knowledge, and referral practices of non-dental health care professionals at federally qualified health centers in regard to recognition, prevention and treatment of early childhood caries
- Creators
- Asana Mohamad
- Contributors
- Michelle R. McQuistan (Advisor)Fang Qian (Committee Member)L. Brendan Young (Committee Member)Kecia S. Leary (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Dental Public Health
- Date degree season
- Summer 2025
- DOI
- 10.25820/etd.008126
- Publisher
- University of Iowa
- Number of pages
- xiv, 205 pages
- Copyright
- Copyright 2025 Asana Mohamad
- Grant note
This project was made possible by funding from departmental endowments: Dr. Henry W. Fields, Jr. Scholarship Fund, Jitesh Chandra and Arati Chowdhury Family Fund, Iowa Pediatric Dentistry Excellence Fund, and Pediatric Academic Enrichment Fund as well as by the Health Resources and Services Administration (HRSA) Grant D88HP37557 and by the 2024 James S. and Janice I. Wefel Memorial Research Award.
(iv)- Language
- English
- Date submitted
- 05/20/2025
- Description illustrations
- Illustrations, graphs, charts, tables
- Description bibliographic
- Includes bibliographical references (pages 165-173).
- Public Abstract (ETD)
This study investigated which of 6 oral health services (OHS) non-dental healthcare professionals provide at federally qualified health centers (FQHCs) to prevent cavities in children 0-5 years of age. It also examined providers : 1) confidence in delivering OHS, 2) oral health knowledge, and 3) referral practices to dentists. A 62-item online survey was developed and distributed to FQHC medical providers nationwide. OHS scores were categorized as few =0-4 vs. many =5-6. Confidence in providing OHS was categorized as more confident vs. less confident. Statistical tests were conducted. Eighty surveys were completed. Forty-three percent of respondents provided few OHS, while 57% provided many. Most respondents did not provide fluoride varnish nor feel confident applying it. Providing OHS and confidence providing OHS were significantly associated with provider type. Assistant physicians, nurse practitioners, physician assistants, and physicians were more likely to deliver OHS and report more confidence than medical assistants, nursing assistants, and nurses (LPN/RN). More confidence and having >50% patients with Medicaid were also associated with providing more OHS. Having a patient population composed of >25% children 0-5 years of age and knowing the state s fluoride varnish guidelines were associated with increased confidence providing OHS. While overall oral health knowledge was good, most respondents did not know at what age young children should first visit the dentist or begin to use fluoride toothpaste. Most participants voluntarily referred patients to dentists within their own organization. Future studies should assess why providers deliver OHS in the absence of workplace directives.
- Academic Unit
- Preventive and Community Dentistry
- Record Identifier
- 9984948642502771
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