Question 1

An inner-city community center has existed in your city for several decades to serve the local urban community. The center has provided varied social services to the community and offered a meeting place for the community members. Twenty years ago the center added a comprehensive health center that was approved and funded as a Federally Qualified Health Center (FQHC) by the Health Resources and Services Administration (HRSA). The FQHC has been providing comprehensive dental services for the last 10 years. However, a staff pediatrician at the FQHC has noted that she is unable to get dental appointments for her patients who have obvious dental caries. Dental services are primarily adult focused, with less than 7% of dental patients in the pediatric age range. Concerned about this problem of limited pediatric dental service availability, the pediatrician collaborated with colleagues to develop a proposal for presentation to the governing board of the health center to expand pediatric oral health services to include screening and risk assessment followed by preventive services, oral examination, and necessary dental treatment. The board accepted the proposal and appointed a committee to explore solutions and develop a grant proposal for increased HRSA funding to accomplish this goal.

-This community center is taking a proactive approach to changing the systems, people, relationships, and resources that enable it to perform a dental public health function. These changes represent which of the following concepts?

A) Oral health capacity
B) Oral health infrastructure
C) Teledentistry
D) Pluralistic system of healthcare delivery

Oral health infrastructure

Accepted Answer

Oral health infrastructure consists of the systems, people, relationships, and resources that enable federal, state, and local dental public health programs to perform public health functions. Expanding the pediatric capacity of the FQHC dental clinic requires a change in infrastructure. Oral health capacity is the ability to perform activities and withstand threats; capacity is used to describe the oral healthcare system as well as the workforce and is affected by the infrastructure. In this case, changing the infrastructure will improve the capacity of this FQHC to meet the oral healthcare needs of the children. Teledentistry is the use of information technology and telecommunication for dental care, consultation, education, and public awareness. Teledentistry could be implemented in a community health center such as this to connect the oral healthcare workers to pediatric dentistry specialists at a dental school in another city in the state. The oral healthcare delivery system is referred to as pluralistic because it uses a combination of public and private funding sources that coexist simultaneously; a pluralistic system tends to be fragmented, uncoordinated, and complex with many elements and entry points. However, the FQHC is a publicly funded system that provides coordinated, comprehensive medical and dental care.

Question 2

An inner-city community center has existed in your city for several decades to serve the local urban community. The center has provided varied social services to the community and offered a meeting place for the community members. Twenty years ago the center added a comprehensive health center that was approved and funded as a Federally Qualified Health Center (FQHC) by the Health Resources and Services Administration (HRSA). The FQHC has been providing comprehensive dental services for the last 10 years. However, a staff pediatrician at the FQHC has noted that she is unable to get dental appointments for her patients who have obvious dental caries. Dental services are primarily adult focused, with less than 7% of dental patients in the pediatric age range. Concerned about this problem of limited pediatric dental service availability, the pediatrician collaborated with colleagues to develop a proposal for presentation to the governing board of the health center to expand pediatric oral health services to include screening and risk assessment followed by preventive services, oral examination, and necessary dental treatment. The board accepted the proposal and appointed a committee to explore solutions and develop a grant proposal for increased HRSA funding to accomplish this goal.

-The committee is researching workforce issues in relation to staffing the dental clinic to be able to provide cost-effective, high-quality comprehensive dental care. All of the following EXCEPT one are accurate statements regarding the oral health workforce. Which one is the EXCEPTION?

A) The oral health workforce is and will be unable to meet the present-day and future demand and need for dental care.
B) The allied oral health workforce-for example, dental hygienists and new workforce models such as mid-level providers-are central to meeting the increasing demand for dental care.
C) The current and anticipated future diversity of the oral health workforce is adequate to provide culturally competent care to our diverse population.
D) The trend in the number of dental Health Professional Shortage Areas (HPSAs) reflects a maldistribution and an inadequate supply of dental manpower.

The current and anticipated future diversity of the oral health workforce is adequate to provide culturally competent care to our diverse population.

Accepted Answer

Based on current dental school enrollment trends in terms of diversity and on the increase in the racial and ethnic diversity of the population, the future dental workforce is expected to remain unrepresentative of the population it serves. This lack of diversity has contributed to problems with dental public health capacity. The oral health workforce is and will be unable to meet present day and future demand and need for dental care because of workforce demographics (shortage of dentists), changing population trends (anticipated greater diversity), and increasing public dental insurance coverage (provisions of the Affordable Care Act). Dental hygienists will be increasingly more available to meet the dental care needs of the population as the trend of greater numbers of dental hygienists and fewer dentists continues. In some states, expanded function and unsupervised dental hygienists and mid-level providers are successfully filling the gap and responding to the need to increase the supply and distribution of the workforce needed to meet the demands for oral health care. These new workforce models are able to provide cost-effective, high-quality care and increase the capacity of dental public health programs. Future workforce recommendations to improve access to care include increasing the numbers of oral care providers, increasing the diversity of the workforce, and using alternative workforce models such as dental hygienists with an expanded scope of practice and mid-level providers to compensate for reduced numbers of dentists.

Question 3

An inner-city community center has existed in your city for several decades to serve the local urban community. The center has provided varied social services to the community and offered a meeting place for the community members. Twenty years ago the center added a comprehensive health center that was approved and funded as a Federally Qualified Health Center (FQHC) by the Health Resources and Services Administration (HRSA). The FQHC has been providing comprehensive dental services for the last 10 years. However, a staff pediatrician at the FQHC has noted that she is unable to get dental appointments for her patients who have obvious dental caries. Dental services are primarily adult focused, with less than 7% of dental patients in the pediatric age range. Concerned about this problem of limited pediatric dental service availability, the pediatrician collaborated with colleagues to develop a proposal for presentation to the governing board of the health center to expand pediatric oral health services to include screening and risk assessment followed by preventive services, oral examination, and necessary dental treatment. The board accepted the proposal and appointed a committee to explore solutions and develop a grant proposal for increased HRSA funding to accomplish this goal.

-All of the following factors EXCEPT one have the potential to affect the oral health capacity of this FQHC. Which one is the EXCEPTION?

A) Medicaid dental coverage for very young children is expected to increase as provisions of the Affordable Care Act (ACA) passed in 2010 are implemented.
B) The interprofessional collaborative practice (ICP) approach of the center is designed to integrate oral health care into the overall healthcare delivery system.
C) FQHCs provide comprehensive, culturally competent, and high-quality primary healthcare services.
D) FQHCs are required to employ teledentistry.

FQHCs are required to employ teledentistry.

Accepted Answer

FQHCs are not required to employ teledentistry although many do so to be able to enhance workforce capacity and increase access to dental care, especially if they are located in remote areas. The ACA has provisions to increase Medicaid coverage for children and adults and to increase HRSA funding of FQHCs. ICP by definition integrates oral and overall health care, which increases the capacity to address the oral-systemic link in day-to-day practice. Also by definition, FQHCs provide comprehensive care and are community centered to increase cultural competence. These characteristics result in increased capacity to provide high-quality primary healthcare services.

Question 4

An inner-city community center has existed in your city for several decades to serve the local urban community. The center has provided varied social services to the community and offered a meeting place for the community members. Twenty years ago the center added a comprehensive health center that was approved and funded as a Federally Qualified Health Center (FQHC) by the Health Resources and Services Administration (HRSA). The FQHC has been providing comprehensive dental services for the last 10 years. However, a staff pediatrician at the FQHC has noted that she is unable to get dental appointments for her patients who have obvious dental caries. Dental services are primarily adult focused, with less than 7% of dental patients in the pediatric age range. Concerned about this problem of limited pediatric dental service availability, the pediatrician collaborated with colleagues to develop a proposal for presentation to the governing board of the health center to expand pediatric oral health services to include screening and risk assessment followed by preventive services, oral examination, and necessary dental treatment. The board accepted the proposal and appointed a committee to explore solutions and develop a grant proposal for increased HRSA funding to accomplish this goal.

-This community center is taking a proactive approach to changing the systems, people, relationships, and resources that enable it to perform a dental public health function. These changes represent which of the following concepts?

A) Oral health capacity
B) Oral health infrastructure
C) Teledentistry
D) Pluralistic system of healthcare delivery

Oral health infrastructure

Accepted Answer

By definition, an FQHC serves an underserved vulnerable population and provides care at a reduced cost on a sliding scale to increase access to care. Children from low-income families are most likely to qualify for Medicaid and CHIP. Income eligibility requirements are more stringent for Medicaid; children can qualify for CHIP with slightly higher family income. The Affordable Care Act passed in 2010 expanded availability of Medicaid to increase access to oral health care for this population. Reciprocally, this population is least likely to have private dental insurance and cannot afford to pay for dental care out of pocket. HRSA is the federal agency that funds the FQHC, but it does not directly pay for services. The center receives payment for services from the third-party provider (e.g., Medicaid or CHIP) by filing for reimbursement after the services have been provided.

Question 5

An inner-city community center has existed in your city for several decades to serve the local urban community. The center has provided varied social services to the community and offered a meeting place for the community members. Twenty years ago the center added a comprehensive health center that was approved and funded as a Federally Qualified Health Center (FQHC) by the Health Resources and Services Administration (HRSA). The FQHC has been providing comprehensive dental services for the last 10 years. However, a staff pediatrician at the FQHC has noted that she is unable to get dental appointments for her patients who have obvious dental caries. Dental services are primarily adult focused, with less than 7% of dental patients in the pediatric age range. Concerned about this problem of limited pediatric dental service availability, the pediatrician collaborated with colleagues to develop a proposal for presentation to the governing board of the health center to expand pediatric oral health services to include screening and risk assessment followed by preventive services, oral examination, and necessary dental treatment. The board accepted the proposal and appointed a committee to explore solutions and develop a grant proposal for increased HRSA funding to accomplish this goal.

-All of the following factors EXCEPT one have the potential to affect the oral health capacity of this FQHC. Which one is the EXCEPTION?

A) Medicaid dental coverage for very young children is expected to increase as provisions of the Affordable Care Act (ACA) passed in 2010 are implemented.
B) The interprofessional collaborative practice (ICP) approach of the center is designed to integrate oral health care into the overall healthcare delivery system.
C) FQHCs provide comprehensive, culturally competent, and high-quality primary healthcare services.
D) FQHCs are required to employ teledentistry.

FQHCs are required to employ teledentistry.

Accepted Answer

Numerous recommendations have been made that are designed to increase access to dental care. Several of those recommendations are listed in this question. Transitioning from a pluralistic system to an entirely public system of providing oral health care is not one of them. Pluralism is valued by modern societies and can be an asset in that it can enhance efficiency if designed and managed properly. The Affordable Care Act has provisions to authorize funding for new workforce models and to increase funding for community health centers and school-based health centers. A Healthy People 2020 objective is to increase the proportion of community health centers that have an oral health component. The interprofessional collaborative approach to practice and education is one of the key elements recommended to increase access. Increasing the use of teledentistry has been suggested to enhance interprofessional collaboration, increase workforce capacity, and bring oral health care to hard-to-reach areas where there are no or very few dentists.

Question 6

Which infectious disease, also known as cancrum oris, is a painful form of gangrene that destroys mucous membranes?&#10;A)Gingivitis&#10;B)Pharyngeal cancer&#10;C)Dental caries&#10;D)Noma

Accepted Answer

Box 5-1: Noma, also known as cancrum oris and gangrenous stomatitis, is a painful form of gangrene that destroys mucous membranes.

Question 7

Which of the following is considered a social impact of oral diseases and conditions on children?&#10;A)Avoidance of talking&#10;B)High attendance rates at school&#10;C)Overeating and overdrinking&#10;D)A high self-concept

Accepted Answer

Box 5-2: Social impacts of oral diseases and conditions on children include delayed growth and development, poor self-concept, avoidance of talking, poor school performance, missed school days, avoidance of smiling, and difficulty eating and drinking.

Question 8

_____________ can be very effective in preventing dental caries on the pit and fissure surfaces of the teeth, but few children receive it/them.&#10;A)Fluoride&#10;B)Dental sealants&#10;C)Filled cavities&#10;D)Flossing

Accepted Answer

Dental sealants can be very effective in preventing dental caries on the pit and fissure surfaces of teeth, but few children receive them.

Question 9

Which of the following contributed to a major decline in the prevalence and severity of dental cavities in the second half of the 20th century?&#10;A)The use of more dental sealants&#10;B)More people flossing regularly&#10;C)Community water fluoridation&#10;D)More frequent dental visits

Accepted Answer

During the second half of the 20th century, a major decline in the prevalence and severity of dental caries resulted from the use of fluorides as an effective method of preventing caries.

Question 10

What can be defined as &#34;the loss of all natural teeth?&#34;&#10;A)Dental caries&#10;B)Edentulism&#10;C)Tooth decay&#10;D)Root canal

Accepted Answer

Edentulism is the loss of all natural teeth.

Question 11

Of all the possible birth defects, what is one of the most common?&#10;A)Malocclusion&#10;B)Cleft lip&#10;C)Craniofacial injuries&#10;D)Missing limb

Accepted Answer

The answer of Of all the possible birth defects, what...

Question 12

What term is used to describe health insurance that uses techniques to control the cost of providing benefits, including contracts with providers at reduced costs?&#10;A)Medicaid&#10;B)Medicare&#10;C)Universal health care&#10;D)Managed care

Accepted Answer

The answer of What term is used to describe health...

Question 13

All states provide dental benefits for children up to age 19 who are enrolled in Medicaid via the mandatory ___________ benefit.&#10;A)Early Childhood Screening Treatment&#10;B)Early and Periodic Screening, Diagnostic, and Treatment&#10;C)Early Childhood Screening of Oral Health&#10;D)Early and Periodic Oral Health Services

Accepted Answer

The answer of All states provide dental benefits for children...

Question 14

According to Title XVIII of the Social Security Act, what is the federal insurance program enacted in 1965 and administered by the Social Security Administration to provide health care for adults ages 65 and older?

A)Medicaid
B)Fee-for-service
C)Medicare
D)Preferred provider organization

Accepted Answer

The answer of According to Title XVIII of the Social...

Question 15

What is the term used to describe the use of information technology and telecommunication for dental care, consultation, education, and public awareness?&#10;A)Teledentistry&#10;B)Autodentistry&#10;C)E-dentistry&#10;D)Communicative dentistry

Accepted Answer

The answer of What is the term used to describe...

Deck 5: Population Health