San Antonio scientists investigate impact of violence on rates of dental care use

Our understanding of the interconnectedness between dental and medical health has grown immensely in recent years and is paving the way for new research. Dental care is an essential part of both oral health and overall physical health, but nearly two in five American adults report not having a dental care visit in the past year.

A study led by scientists from The University of Texas Health Science Center at San Antonio (UT Health San Antonio) School of Dentistry and UTHealth Houston School of Public Health at San Antonio aims to improve use of dental care as well as inform development of violence-reduction interventions that can be used by dental health practitioners.

Peter M. Loomer, BSc, DDS, PhD, MBA, FACD, FICD

“This study, funded by the National Institutes of Health and conducted through our school’s Center for Global and Community Oral Health, is an important step in informing the development of interventions and services to improve access to dental care in communities with high rates of violence. By understanding how violence affects dental care utilization, we can refine the care offered and make a positive impact on the health of some of our most vulnerable populations,” said Peter M. Loomer, BSc, DDS, PhD, MBA, FACD, FICD, dean and professor with the UT Health San Antonio School of Dentistry and director of the Center for Global and Community Oral Health.

The study is the first to investigate long-term patterns of violence in communities and how it may affect the use of dental health care across various life stages.

“This research will help identify how violence, both personal and community-based, creates barriers to health care, including dental care. How can we guide policies and programs to improve access to dental services for these affected areas, especially those experiencing high rates of violence?” said Rahma Mungia, BDS, MSc, DDPHRCS, associate professor with the Department of Periodontics, director of the South Texas Oral Health Network and assistant director of the Southwest Region, National Dental Practice-Based Research Network — regional and national networks that conduct practice-based dental research.

Practice-based research is clinical studies focused on procedures and everyday outcome measures, fundamentally collecting the information in real-world settings.

Co-principal investigator for this study is Alexander Testa, PhD, assistant professor in the Department of Management, Policy and Community Health at UTHealth Houston School of Public Health at San Antonio. Testa is a leading expert in understanding the health consequences of violence and exposure to related risks.

Violence is a public health issue

“Community violence exposure is a serious public health issue affecting millions of Americans each year. Understanding its impact on dental care access and use is essential, as it may disrupt preventive care and worsen health disparities. Dental professionals, particularly those serving children and young adults, are uniquely positioned to help address this issue. By screening patients for violence exposure and partnering with community organizations that support victims, they can play a pivotal role in improving care and advancing health equity for vulnerable populations,” said Testa.

Mungia is the regional principal coordinator for the Southwest node of the National Institutes of Health’s National Institute of Dental and Craniofacial Research (NIDCR) practice-based research network, which oversees programs in Texas, Oklahoma, Kansas, New Mexico and Arizona. The network’s programs have been successful for over a decade in creating understanding about how environmental and social situations can affect dental and physical health. Mungia said the research network is moving toward further integration of dental and medical research. She shifted her focus several years ago to incorporate social determinants of health and other societal issues into her dental practice-based research.

“Moving into this medical-dental integration is the future of where [NIDCR] wants us to be,” Mungia said.

Patterns of violence, real-world interventions

While previous research supports the fact that exposure to childhood violence or interpersonal violence negatively affects dental care use, there is little research about how patterns of violence in a community may affect dental care.

Mungia hypothesizes there is an inverse correlation showing the higher the frequency and level of violence in a community, the lower the use of dental care. This study will provide data to inform clinical trials and practice-based research in the field.

The research team will conduct an analysis of three longitudinal data sets: the National Longitudinal Study of Adolescent to Adult Health, the Future of Families and Child Wellbeing Study and the Neighborhood Gun Violence and Health in 100 Cities to determine whether there is a relationship between exposure to violence and use of dental care from adolescence to adulthood. Additionally, the data will establish if there is a connection between exposure to violence in the community and dental care use from childhood to young adulthood and if race, ethnicity or socioeconomic status are factors in use.

Tap into the network

A quick poll conducted by the NIDCR practice-based network found that only 17.2% of dental professionals polled asked about violence exposure on patient health history forms, but just over half said screening for violence exposure should be part of dental care. Mungia said this indicates that while most dental professionals are not screening patients for violent exposure, they are open to learning more about how to counsel their patients on the topic.

The next step after this study will be to develop a clinical trial and further research through the practice-based network. Ultimately, Mungia said they would aim to create a counseling program for practitioners. The network previously created a short five-step program that could be adapted to counsel patients on violence in their community and the importance of dental care. Identifying individuals who are likely to be affected by violence and giving them counseling and referral to resources could someday become a routine part of dental health care, said Mungia.



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