Purpose: We aim to understand the impact of the COVID-19 on health care utilization and oral health conditions of patients at federally qualified health centers (FQHCs), where patients are disproportionately low income, publicly insured, or uninsured. Methods: Using deidentified electronic health records of patients at FQHCs in the United States from January 2019 through December 2020 ( n = 431,509), variations in health care utilization since the COVID-19 outbreak were observed by procedure types and patient characteristics. Changes in dental utilization and oral health conditions were characterized using mixed-effect negative binomial and logistic regression models. Results: Dental utilization decreased more drastically than medical utilization during shelter-in-place periods in 2020 and rebounded more slowly after the reopening. Greater demands for oral surgery and teledentistry and less demands for preventive services were observed in 2020. As compared to 2019, patients experienced more psychological stress–related dental conditions with odds ratios of 1.52 (95% confidence interval [CI], 1.31–1.76) for uninsured, 1.48 (95% CI, 1.07–2.02) for Medicaid enrollees, and 2.38 (95% CI, 1.68–3.40) for private insurance beneficiaries. Conclusion: As a result of COVID-19, patients received more invasive dental procedures due to delayed treatment and experienced a higher risk of psychological stress–related dental conditions. Continued support for statewide policies to expand access to oral health care and oral health promotion strategies for the vulnerable populations would be encouraged. Knowledge Transfer Statement: Our study describes the impact of COVID-19 on dental care use and oral health conditions at Federally Qualified Health Centers, targeted to provide care for some of the most vulnerable populations in the United States. The results of this retrospective cohort study can be used by clinicians and policymakers on understanding the clinical needs of the vulnerable populations after the pandemic. It highlights the need for continued support to expand access to oral health care and oral health promotion to these populations.

Periodontitis is a severe infection affecting oral and systemic health and is traditionally diagnosed through clinical probing—a process that is time-consuming, uncomfortable for patients, and subject to variability based on the operator’s skill. We hypothesized that computer vision can be used to estimate periodontal stability from radiographs alone. At the tooth level, we used intraoral radiographs to detect and categorize individual teeth according to their periodontal stability and corresponding treatment needs: healthy (prevention), stable (maintenance), and unstable (active treatment). At the patient level, we assessed full-mouth series and classified patients as stable or unstable by the presence of at least 1 unstable tooth. Our 3-way tooth classification model achieved an area under the receiver operating characteristic curve of 0.71 for healthy teeth, 0.56 for stable, and 0.67 for unstable. The model achieved an F ₁ score of 0.45 for healthy teeth, 0.57 for stable, and 0.54 for unstable (recall, 0.70). Saliency maps generated by gradient-weighted class activation mapping primarily showed highly activated areas corresponding to clinically probed regions around teeth. Our binary patient classifier achieved an area under the receiver operating characteristic curve of 0.68 and an F ₁ score of 0.74 (recall, 0.70). Taken together, our results suggest that it is feasible to estimate periodontal stability, which traditionally requires clinical and radiographic examination, from radiographic signal alone using computer vision. Variations in model performance across different classes at the tooth level indicate the necessity of further refinement.

The Global Health Starter Kit (GHSK) is an interdisciplinary, competency-based, open access global health curriculum covering global disease and demographic trends, Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), the connection between oral health and overall health, social determinants of health, and concepts of sustainable and ethical global health programs. In this study, we evaluate and describe barriers to and facilitators for using and implementing the GHSK curriculum across a variety of new users. This two-phase study uses the Roger’s Adoption Curve concept to standardize this evaluation and inform a strategic plan for continuing to move the curriculum across the chasm from early adopters to an early majority of global oral health educators and learners. We utilized a theoretical adoption framework to identify facilitators and barriers under the domains of innovation and curricular, educator and learner, and institutional and structural factors. Under qualitative Phase 1, five early adopter institutions were interviewed to elicit understanding of factors that contribute to adoption of the GHSK curriculum. Common themes identified were next used to create a Phase 2 quantitative survey for early majority subscribers of the GHSK (N = 27). These qualitative and quantitative results showed an overall high satisfaction with the quality of the GHSK materials, but also effectively identified barriers to its adoption, including inexperience of faculty in teaching global oral health, a lack of awareness and marketing, and absence of global health accrediting requirements. By identifying the barriers and facilitators of GHSK curriculum integration, this study provides concrete and specific opportunities to improve its format, relevance, content, and delivery. This study outlines next steps to creating a standardized approach to successfully adopting competency-based global oral health teaching and learning.

Harvard School of Dental Medicine’ Initiative to Integrate Oral Health and Medicine, in collaboration with Harvard’s Center for Integration Science and Global Health Institute, convened global experts in integration science and medical dental integration specifically, to call attention to the need for universal health coverage concepts that incorporate essential oral health services and thereby address equity and population health gaps. Across the globe, there are many innovative financial, clinical and educational programs that strive to provide comprehensive and universal healthcare that includes oral health. The goal of the symposium was to showcase successful examples of programs and policies that are improving health and quality of life, particularly for communities suffering disparities, through the integration of oral healthcare into primary and secondary levels of care. Symposium participants ranged from ministers of health to village healthcare workers to academics, who shared their successes and challenges integrating medical and oral healthcare. However, despite innovative examples spanning integration of care for infectious and noncommunicable diseases as well as social determinants, more work is required to: heighten awareness of the essentialism of oral health; strengthen the evidence for effective oral healthcare; and highlight the opportunity to improve health and equity through interprofessional collaboration. This commentary presents the key points from a subject matter expert discussion, theorizing through the lens of political economy about the challenges to advance the integration of oral healthcare within universal healthcare, and how the inspiring examples of success showcased throughout during the symposium surmounted systemic and cultural barriers to holistic care.