Whiteman Lauren N, Haywood Carlton, Lanzkron Sophie, Strouse John J, Batchelor Adrian H, Schwartz Anthony, Stewart Rosalyn W
From the Departments of Medicine, Pediatrics, and Otolaryngology, and the Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.
South Med J. 2016 Sep;109(9):576-8. doi: 10.14423/SMJ.0000000000000510.
Poor oral health can have a negative impact on overall health. This is especially concerning for individuals with sickle cell disease (SCD), an inherited blood disorder that affects hemoglobin and can lead to an increased risk of infection and hyperalgesia. Because the majority of individuals with SCD have Medicaid insurance and no dental coverage, we provided free basic dental care to individuals with SCD to determine whether it decreased overall healthcare utilization.
Through a contract with a private dental office, we provided free basic dental care (eg, cleanings, fillings, x-rays) to individuals with SCD. We reviewed medical records for the 12 months before and after their initial dental visit to determine whether there were any changes in acute care visits (defined as a visit to the emergency department, sickle cell infusion center, or visits to both in the same day), hospitalizations, and total days hospitalized. We conducted a negative binomial regression to determine any differences in the pre-post periods.
In our multivariable analysis, there was a statistically significant decrease in hospital admissions. In addition, there was a significant decrease in total days hospitalized if dental work was completed, but an increase in days hospitalized in men.
Providing dental care to individuals with SCD who did not have dental insurance did not greatly alter acute care visits. A larger sample size may be necessary to observe an effect.
口腔健康状况不佳会对整体健康产生负面影响。对于镰状细胞病（SCD）患者而言，这一问题尤为令人担忧。镰状细胞病是一种遗传性血液疾病，会影响血红蛋白，并可能导致感染风险增加和痛觉过敏。由于大多数SCD患者拥有医疗补助保险，但没有牙科保险，我们为SCD患者提供了免费的基本牙科护理，以确定这是否会降低整体医疗保健利用率。
通过与一家私人牙科诊所签订合同，我们为SCD患者提供了免费的基本牙科护理（如洗牙、补牙、X光检查）。我们查阅了患者初次牙科就诊前后12个月的病历，以确定急性护理就诊（定义为前往急诊科、镰状细胞输注中心就诊或同一天内两者都就诊）、住院情况和住院总天数是否有任何变化。我们进行了负二项回归分析，以确定前后时期的任何差异。
在我们的多变量分析中，住院人数有统计学意义的下降。此外，如果完成了牙科治疗，住院总天数显著减少，但男性住院天数增加。
为没有牙科保险的SCD患者提供牙科护理并没有显著改变急性护理就诊情况。可能需要更大的样本量才能观察到效果。
