Patients with facial fractures are disproportionately uninsured or underinsured, creating a substantial economic burden for trauma systems. Although the Affordable Care Act (ACA) significantly expanded Medicaid eligibility, its effect on insurance coverage among adults with facial trauma remains poorly defined. The purpose of the study was to evaluate the association between ACA implementation and Medicaid coverage among adults presenting with isolated facial fractures. This was a retrospective cohort study using the American College of Surgeons National Trauma Data Bank from 2008 to 2019. Adults with isolated facial fractures were included. Patients with polytrauma or missing data were excluded. The primary predictor was time period relative to ACA implementation, defined as pre-ACA (2008 to 2013) or post-ACA (2014 to 2019). The primary outcome was insurance payor at the time of encounter (Medicaid vs non-Medicaid). Covariates included demographic (age, sex), clinical (Charlson comorbidity index), injury-related (injury severity score, fracture location), and hospital characteristics (teaching status, bed size). Descriptive, bivariate, and multivariable logistic regression statistics were performed to evaluate the association between ACA implementation and Medicaid coverage. A threshold of P < .001 was considered significant for all analyses. A total of 187,803 subjects were included of which 47,315 (25%) were treated pre-ACA and 140,488 (75%) were treated post-ACA. The cohort had a mean age of 44.8 ± 20.2 years, was 73% male (n = 137,408), and 64% White (n = 119,674). Medicaid coverage increased from 16% pre-ACA to 24% post-ACA, with a corresponding decrease in self-pay from 30 to 20% (P < .001). After adjustment for demographic, clinical, injury-related, and hospital covariates, post-ACA treatment was associated with significantly higher odds of Medicaid coverage (odds ratio [OR]: 1.93, 95% CI: 1.88 to 1.99, P < .001). The relative increase in Medicaid coverage was greater at non-level 1 centers (OR: 1.93, 95% CI: 1.82 to 2.04, P < .001) compared to level 1 centers (OR: 1.34, 95% CI: 1.29 to 1.40, P < .001). ACA implementation was associated with increased Medicaid coverage and reduced uninsured status. Medicaid expansion improved access to care; similar efforts may enhance the sustainability of facial trauma services within modern trauma systems.

Background: Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists’ limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the attitudes and experiences that Black men have communicating with dentists about OPCs. Methods: To qualitatively assess these attitudes and experiences, a focus group guide and recruitment strategy were developed using a community engagement approach. Data were analyzed using grounded theory. Results: Twenty-three self-identified Black men participated in three focus groups through the Zoom platform (mean age of 46.1 years). Four main themes emerged, which identified that participants: (1) had little knowledge of OPCs; (2) felt that addressing OPC risk among Black men was not a priority for dentists; (3) stressed the importance of dentists acknowledging the complexity of how race and gender affects Black men’s healthcare experiences; and (4) expressed a benefit to receiving information from multiple social networks. Conclusion: The focus groups provided context for how dentists might engage with Black men in discussions about OPC prevention and treatment.

Traditional fee-for-service Medicare rarely covers oral health services.¹ Medicare beneficiaries in racial and ethnic minority groups and with lower socioeconomic status (SES) are less likely to have recent dental visits than their counterparts.² Unlike traditional Medicare, most Medicare Advantage (MA) plans offer access to oral health services,² and enrollment in MA has been highest among historically underserved adults 65 years or older.³ In this study, we aimed to assess the prevalence and likelihood of having MA plans offering dental coverage among beneficiaries by sociodemographic factors.

Aim: Our aim was to examine the association between emergency dental care use and dental providers’ availability and ZIP code social vulnerability index. Methods: This cross-sectional observational study mapped variations in emergency dental care and analyzed their association with social vulnerability using generalized spatial two-stage least-squares to address spatial correlation. To perform spatial autoregressive modeling to examine how dental provider capacity and social vulnerability influence emergency care use across neighboring counties, accounting for ZIP Code Tabulation Area (ZCTA) spillover effects, we used secondary data from the Maryland Health Services Cost Review Commission, InfoUSA, and the US Census American Community Survey. We focused on emergency dental care usage in ZIP Code Tabulation Areas, using emergency department visits and inpatient stays per 1000 residents for dental conditions, as the dependent variable. Results: Highly vulnerable ZCTAs saw 5.9× more non-traumatic dental condition (NTDC) ED visits, 5.3× more chronic dental ED visits, 3.3× more NTDC inpatient stays, and 1.3× more chronic dental inpatient stays than less vulnerable areas. For all four measures of emergency dental care use, increased dental provider availability was associated with reductions in use of emergency dental care (ED), while higher social vulnerability was associated with increased use. For example, an increase of one dental provider per 1000 residents was associated with a reduction of 28.2 non-traumatic dental ED visits, while a high social vulnerability index was associated with an increase of 88.6 non-traumatic dental ED visits. Conclusions: There was an association among dental provider availability, social vulnerability, and the use of emergency dental care.