Do We Have Dental Service In Mercy Hospital

• Research article
• Open Access
• Published: xiii July 2018

Mission of Mercy emergency dental clinics: an opportunity to promote general and oral health

• Susan Passmore^ane,2,
• Craig S. Fryer^i,3,
• Jie Chen^1,2,
• Dushanka V. Kleinman^4,5,
• Alice K. Horowitz^3,4,
• James Butler Iii^i,three,
• Mary A. Garza^1,3,
• Sandra C. Quinn^one,6 &
• Stephen B. Thomas^1,2

BMC Public Wellness book 18, Article number:878 (2018) Cite this article

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Abstract

Background

Mission of Mercy (MOM) emergency dental clinics are a resource for populations lacking admission to dental care. We designed a MOM consequence incorporating health equity components with established community partners who shared a mutual vision of addressing the oral health, physical health, and social service needs of Maryland and Washington, DC surface area residents. Although studies have explored associations betwixt oral and chronic wellness conditions, few studies to our knowledge have examined the relationship between these conditions and receipt of dental services. Therefore, this report explored these associations and the opportunity for better care coordination.

Methods

Oral health data from the 2014 Mid-Maryland Mission of Mercy and Wellness Disinterestedness Festival outcome was analyzed. A descriptive analysis assessed frequencies and percentages of participant sociodemographics characteristics, oral wellness and chronic disease chance(due south), and dental services delivered. Chi-square tests and multivariate logistic regression were conducted to determine the associations between 1) oral health and chronic disease adventure(s) and dental services; and 2) oral health and chronic disease risk(southward) and participant characteristics.

Results

Approximately 66.2% (n = 666) of the 1007 participants had one or more than chronic weather condition and/or take a chance factors (diabetes, high blood pressure, and tobacco employ). These individuals had a significantly higher likelihood of receiving an oral surgery process (specifically, tooth extraction) (only one condition/gamble: OR = ii.forty, 95%, CI = one.48–three.90, p < .001; two weather condition/risks: OR = three.12, 95% CI = i.78–5.46, p < .001).

Decision

The 2014 Mid-Maryland Mission of Mercy emergency dental dispensary attracted people with hazard factors for oral and chronic diseases. Those with one or more risk factors were more likely to receive oral surgery (specifically, tooth extraction). These findings strongly suggest that organizers of MOM emergency dental clinics include wrap-effectually primary care, wellness promotion and illness prevention services along with provision of dental services. While such events will not solve the general and oral health challenges of participants, nosotros believe they provide an opportunity to provide basic preventive services. These findings also present an opportunity to inform planning for futurity MOMs and emphasize the importance of using these public wellness events to create linkages with other services to support follow-up and care coordination.

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Groundwork

In that location is a growing body of prove that having poor oral wellness is linked to chronic diseases such as diabetes [one,ii,iii] and middle disease [4, 5]. In addition, tobacco use is a run a risk factor for periodontal diseases and oral cancers [6, 7]. The primary aim of this written report was to explore the human relationship between chronic diseases and the types of dental services performed at a Mission of Mercy (MOM) emergency dental clinic.

Mission of Mercy (MOM) emergency dental programs have become a frequent choice of last resort for far as well many people in need of dental care. These community-based, voluntary dental care settings occur annually throughout the country and concenter large numbers of individuals seeking intendance for dental-related pain and disease. Many individuals seek care from periodic dental events such every bit MOMs due to the economical and policy issues related to the provision of oral health services for underserved populations. These problems include lack of funds to pay for adult dental services [8, 9], beingness uninsured and underinsured [x], and Medicaid dental benefits that vary from state to land [11] and seldom cover actual cost of dental care. Some MOMs also provide medical intendance and health education services in add-on to traditional dental intendance services [12] in an endeavour to accost other wellness needs of the MOM attendees.

In 2014, the Academy of Maryland Center for Wellness Disinterestedness (M-CHE) in collaboration with Cosmic Charities of the Archdiocese of Washington, DC, and the Maryland Land Dental Association organized a two-and-a-half-day MOM event. The event included a new component for MOM programs in the state, a Wellness Equity Festival (HEF) comprised of master intendance medical screenings, health didactics and navigation support for ameliorate care coordination. This was M-CHE'south showtime feel conducting a MOM event and the partnership was an opportunity to extend activities of critical relevance to achieving wellness equity and improving population health by providing the community with comprehensive services that addressed their immediate dental needs, likewise as other related healthcare needs. Thomas et al. [13], describe how MOM participants seeking emergency dental services go far with take chances factors for other chronic disease typically cared for in principal medical care settings. However, given that MOM events are infrequent, fourth dimension-limited, and focused predominantly on dental care, the capacity to provide additional primary care and social services is challenging. Equally function of the collaborative planning with MOM partners, including local hospitals, we created an environment that supported coordinated dental triage and treatment and added value with a complementary Health Equity Festival (HEF) dedicated to medical screening and public health educational activity. The HEF included partnerships with not-profit, private sector, hospital and academic organizations and aimed to provide comprehensive wrap-effectually services. Wellness services were provided, including: HIV testing; carbon monoxide testing, trunk composition measurement, vision screening, influenza vaccinations, nutrition education, oral wellness education, and legal consultations.

Recently, the Communities in Action: Pathways to Health Equity written report [xiv] provided a conceptual model informed by prior models as a guide for practitioners and community members developing effective programs aimed at achieving wellness equity. The model includes three cardinal elements that are necessary when implementing a "customs-driven" initiative in lodge to be effective in addressing health inequities: 1) create a shared vision and value of health equity, 2) increase community capacity to shape health outcomes, and iii) foster multi-sector collaboration [14]. Although this report was published later on our 2014 MOM event, we actually applied these same concepts in the design and operation of the MOM program based on our experience and lessons learned from prior customs-engaged programs that we take implemented. For example, we take more than than fifteen years of experience developing and sustaining partnerships with other entities in an effort to create effective and comprehensive customs health [15,sixteen,17]. Furthermore, the HEF built on the established community partnerships that shared a common vision of addressing needs of underserved populations. Together with these MOM partners, we organized the HEF to address those wellness needs documented by county and state needs assessments, and in the literature [10, 18]. We provided these additional services so MOM participants could be connected to essential networks inside the customs, which they may not have had access to prior to attending the MOM.

Although previous studies have explored the relationship betwixt oral health weather condition and chronic weather condition [i,2,3,iv,5, 7], few studies to our knowledge accept examined the human relationship between the receipt of dental services at a MOM issue and presence of risk behaviors and chronic conditions. This study expands on our prior publication of the 2014 Mid-Maryland MOM and HEF, past examining multiple chronic risks/conditions rather than simply individual risks/conditions (e.g. diabetes) and the human relationship with the type of dental services provided.

Methods

Setting

Nationally, MOM events were established to address imminent dental care needs. A comprehensive planning team addressed volunteer and participant recruitment, equipment and supplies, triage and wellness tape documentation, liability insurance, treatment management and referrals amidst other tasks. Recruitment of licensed provider volunteers was led past the Maryland State Dental Association, and non-clinical support volunteers were recruited and managed by Catholic Charities. The consequence attracted more than 2000 individuals. Staffing this event involved approximately 1462 volunteers, 560 of whom were oral health professionals (dentists, hygienists, assistants) [13].

When planning our two and half twenty-four hours MOM, nosotros wanted to maintain the integrity of the national MOM events and raise ours with the implementation of the HEF. The first solar day, Thursday, was a half-twenty-four hours pre-screening consequence for individuals who received referrals from local community programs due to their emergency dental care needs. This pre-screening made information technology possible to address those with the about unmet dental care needs at the starting time of the opening of the upshot. The MOM dental program opened its doors at 7:00 am on Friday and Saturday for participant registration and medical triage. Participant registration included check-in, medical assessment of health history and current medications, and medical triage: blood pressure screenings, and blood glucose testing, and, if necessary, repeated blood pressure screenings. Participants then were escorted to dental triage to determine primary dental care problems and planned treatment.

These MOM attendees were encouraged to visit the HEF vendors before or later on receiving their dental treatment. Unfortunately, due to demand, limited time, and volunteer staff, we were able to merely serve 1018 participants during the two-and-a-half-day outcome.

Data collection

Data were collected by 1 of our Mid-Maryland MOM partners, ZystemsGO, in their secured HIPAA regulated applied science-based dental record system, DentaleShare. The University of Maryland Institutional Review Board (IRB) determined that our examination of the de-identified dataset did not crave IRB approval for a secondary data assay. Study protocols and procedures were approved past the University of Maryland Institutional Review Board. Nosotros used the following measures from the dental records: sociodemographics; medical history; medications; dental care event; and treatment received. Of the 1018 oral health medical records, 1007 of them were complete and extracted post the event from the organization for the purpose of this study. Sociodemographic and health history information were cocky-reported utilizing a patient intake form (questionnaire) completed during the registration stage and the medical pre-screening triage stage.

Data measures

Sociodemographics

Demographic data included race, ethnicity, sex, and age collected during the registration stage. Race was categorized as white, black, Hispanic, other, and unreported – i.e., individuals who did not study their race and/or ethnicity. Age was categorized into four groups: 18–34, 35–49, 50–64, and 65 years and older. Sex was categorized as male or female person.

Dental services

To document the range and distribution of dental services provided, we categorized blazon of services received as: 1) preventive dental services and ii) dental handling services. Preventive dental services were subcategorized into oral hygiene pedagogy, fluoride varnish, and adult prophylaxis. Dental treatment services were subcategorized into full mouth debridement, restorative, endodontics, or oral surgery (tooth extractions). For purposes of analyzing the clan between chronic conditions and dental services received, nosotros categorized the variable "preventive merely" to include all the preventive services (i.due east., oral hygiene instruction, fluoride varnish, and developed prophylaxis) rather than individually analyzing each service because the sample size was not robust enough to support chi-square analysis. In addition, this preventive variable is mutually exclusive to the dental treatment service variable considering nosotros wanted to determine if receiving no treatment (preventive service just) is associated with an individual'south chronic condition/risk status.

Oral health and chronic illness risk(south)

Three take chances factors (available from the patient intake form completed in triage) of oral health disease and chronic disease risk(due south) were utilized: 1) high claret pressure readings (pre-hypertensive, stage ane hypertension, stage ii hypertension, or isolated hypertension), ii) tobacco use, and three) diabetes. Specifically, participants were asked i) if they had ever been diagnosed by a doctor with diabetes and two) if they use tobacco. Tobacco use was defined as current employ when a participant responded in the affirmative to the question. Additionally, claret force per unit area measures were collected from medical pre-screening.

The oral health and chronic disease gamble(s) variable was categorized into 3 exclusive groups: "none" if the participant had no oral health and chronic illness chance(due south), "one chance only" if the participant had only one wellness risk, and "two risks" if the participant had two health risks. One initial high blood force per unit area reading does not imply loftier blood pressure level diagnosis or hypertension; yet, having hypertension may predispose individuals to sure chronic weather [19]. Therefore, nosotros included this measure in our analysis of the MOM participant profile. Some participants did study a high blood force per unit area diagnosis in their health history record, but the total "north" was not sufficient to include in our assay plan.

Statistical assay

Descriptive statistics were calculated using SPSS (version 23) to assess frequencies and percentages of participant sociodemographics, oral health and chronic disease risk(s), and dental services. We used chi-foursquare tests to determine the associations between 1) oral wellness and chronic illness risk(s) and dental services; and 2) oral health and chronic disease risk(due south) and participant characteristics. A multivariate regression model was conducted to make up one's mind if participants with chronic conditions/risk(due south) were more likely to receive certain dental services.

Results

Participant characteristics

Approximately 49% of the participants cocky-identified as black (n = 494), followed by Hispanic (north = 231, 22.9%), and white (north = 139, thirteen.8%). The bulk of the participants were women (n = 623, 62.0%), and 38.0% (northward = 377) were 18–34 years of age (Table 1). Slightly over seven % of participants were 65 years or older. Approximately two thirds of the sample reported having i or more chronic conditions/gamble(s) – diabetes, high claret pressure reading, and tobacco apply (ane chronic status/chance merely, n = 463, 46%; two chronic conditions/risks, n = 203, 20.2%). Approximately 10.9% (due north = 110) reported diabetes diagnosis, sixteen.4% (n = 165) reported loftier claret force per unit area and sixteen.3% (northward = 164) were tobacco users.

Table 1 Sample characteristics and summary of dental services: preventive intendance, and treatments at 2014 Mid-MD MOM (N = 1007)

Full size table

Existence Hispanic was associated with college likelihood of having just ane chronic status/take a chance, compared with other racial and ethnic groups (Table two). Every bit noted, Hispanic participants (p = .004, n = 113, 48.9%) had the highest per centum of having only ane chronic condition/risk. Whereas, white participants (p = .004, northward = 42, 30.2%) had the highest percentage for having ii chronic weather/risks compared to other racial and ethnic groups. Men were more than probable than women to take only 1 chronic condition/risk (p = .001, due north = 189, 49.5%) and ii chronic atmospheric condition/risks (p = .001, n = 90, 23.6%). Conversely, women were more likely than men to take no chronic conditions/risks (p = .001, n = 236, 37.ix%).

Table 2 Associations of 2014 Mid-Doc MOM patients' characteristics by chronic condition(due south) and run a risk(south)

Full size table

Participants 18–34 years of age (p < .001, n = 157, 41.6%) had the highest percentage of having no chronic conditions/risks while those who were 65 years of historic period and older (p = .001, n = 25, 34.vii%) had the highest pct for 2 chronic conditions/risks.

Dental services delivered

Among the preventive dental services delivered, oral hygiene instruction was the most mutual (north = 344, 34.two%) (Tabular array ane). The near common dental treatment service was restorative (n = 362, 35.nine%). Over a third (n = 433, 43.0%) of the participants received ane or more treatments, but did non receive whatever preventive services, whereas 10% (north = 104, ten.3%) of the sample simply received preventive services.

While 1007 individuals registered, afterwards a participant was assessed in medical triage, the participant may not have received whatsoever service because he/she was deemed medically ineligible as a result of their current medical condition, required pre-medication, or there was not plenty time to provide the necessary dental service (33.four%, north = 336).

Associations of chronic condition(s) and risk(s) with dental services

Bivariate associations (Table iii) revealed having 1 or more chronic weather condition/risks was significantly associated with the likelihood of receiving restorative and oral surgery services (specifically, tooth extraction). Participants with only one chronic status/gamble were significantly more likely to receive a restoration (p < .001, 44.1%) compared to participants with none or ii chronic conditions/risks. Participants had higher probabilities of an extraction when they had more chronic conditions/risks. These chronic conditions/risks were not significantly associated with the likelihood of receiving a preventive service or endodontics.

Tabular array 3 Associations between 2014 Mid-Medico MOM patients' chronic condition(southward) and risk(s) with dental services

Full size tabular array

We used a multivariate logistic regression model to determine if participants with i or more than chronic weather condition/risks were more likely to receive certain dental services, specifically more than invasive services (Table iv). Later controlling for participant characteristics, those who had only one chronic condition/risk were more likely to receive a full oral cavity debridement (only one condition/risk: OR = 2.33, 95%, CI = one.51–three.58, p < .001; 2 conditions/risks: OR = two.08, 95%, CI = 1.23–3.50, p = .001) and an extraction (only one status/risk: OR = 2.40, 95%, CI = one.48–iii.xc, p < .001; two atmospheric condition/risks: OR = 3.12, 95%, CI = 1.78–v.46, p < .001). Respondents with ane status/take a chance were also significantly more than likely to receive a restorative process compared to respondents with no risk factor (OR = 2.05, 95% CI = 1.51–2.80). Likelihood of receiving any restorative procedures were similar among respondents with two or more atmospheric condition/risks and those with no condition/hazard.

Tabular array 4 Multivariate logistic regression of 2014 Mid-MD MOM patients' chronic status(s) and hazard(s) by dental services controlling for patient characteristics

Full size tabular array

Word

Our report reports findings of the relationship between having multiple chronic conditions/risks and receiving invasive (oral surgery-tooth extractions) and other dental services of participants from the 2014 Mid-Maryland Mission of Mercy (MOM) and Health Disinterestedness Festival (HEF). While participants primarily attended the outcome to receive dental intendance; still, our analyses revealed that a third of them had one or more chronic conditions and lifestyle take chances behaviors and that these conditions were more prevalent in older than younger participants. In addition, those with two or more than chronic weather condition and risks were more likely to have oral surgery than those with one condition/risk.

By incorporating a HEF, based on the 3 key elements necessary when implementing a "community-driven" initiative aimed at achieving health equity [xiv], into the traditional MOM format, we helped participants place other health concerns and treatment options – namely, emergency care, coordinated care, oral healthcare services, and main intendance follow-up. Given the relationship between chronic risks similar diabetes, high blood pressure, and oral health diseases, these conditions warrant the need for behavioral changes such as a healthy diet/diet, smoking cessation, practicing oral hygiene, and using fluoride [twenty, 21].

The dental service decisions were frequently based on the "most" urgent need identified by the participant, as well as availability of appropriate dental care providers at the MOM event. Consequently, we recognize that all of the services delivered may non accept been the result of participants' oral wellness and/or general health behavior only were due to limited fourth dimension and resources. Due to varying Medicaid coverage for developed dental care [22], we recognize that certain oral diseases are often untreated, leading to infections, pain, and the disability to eat, which are all associated with more expensive and invasive, yet preventable dental services. Thus, nosotros explored how an individual's general health status impacts receipt of an invasive or non-invasive dental wellness service. Such findings provide prove regarding the demand for comprehensive, combined (general + oral) health services.

Our analysis of the data revealed additional links between chronic conditions/risks and oral healthcare; specifically equally it relates to dental services. Prior inquiry examined oral health behaviors such as hygiene practices [23, 24] and affliction [25]. Our report examined associations with dental services delivered in a MOM community dental setting. An individual having i or more chronic weather condition or oral wellness adventure increased their likelihood of receiving three of the four dental services, preventive, total mouth debridement, restorative, and extractions. Nevertheless, an individual with more than i chronic condition and/or risk had a higher risk of an extraction than full mouth debridement.

In 2015, the American Dental Association conducted an assessment of self-reported oral wellness condition, attitudes, and dental care utilization among Maryland adults, titled Oral Health and Well-Existence in Maryland [26]. According to the report, 25% of low income adults had difficulty accessing a dentist, 31% of center income adults and 41% of high income adults were fearful of visiting the dentist [26]. Our findings reveal that many MOM participants are in need of coordinated care for their primary and dental intendance needs. Although some of these services were based on urgent need, our findings demonstrate that certain services rendered [eastward.g., restorative or oral surgery services (specifically, tooth extraction) due to infections or deterioration] were preventable if the participant had admission to comprehensive dental intendance.

Information technology is also important to note that although the majority of the MOM participants were Hispanic and African American, white participants were more likely to accept two chronic atmospheric condition/risks compared to all other racial and ethnic groups. This may be attributed to our sample non being representative of the general U.S. population. In addition, other factors such equally income, education level, wellness insurance and level of health literacy may contribute to these findings.

We have considered several alternatives for inclusion in future MOM and HEF events: 1) reposition access to the HEF and integrate it into the flow of participant registration and medical triage; 2) permit some participants to enter the HEF prior to receiving their dental service, while others access it after their care; allowing for efficient data collection that neither overburdens the participant nor creates a barrier for the healthcare providers delivering services; 3) include cocky-rated health condition, healthcare coverage, instruction status, physical activity frequency, and body mass alphabetize within the dental record; and 4) create data platforms to merge participant profiles with health and social service referral systems, which could exist linked to appropriate HEF vendors who provide effective follow-up for oral health and primary healthcare to MOM participants, such as federally qualified health centers. These alternatives could ensure that MOM attendees are linked to ongoing principal care and dental services located in shut proximity to their neighborhood.

Conclusion

Our findings reveal that attendees at the 2014 Mid-Maryland Mission of Mercy and Health Disinterestedness Festival were living with multiple risk factors or chronic conditions and in dire demand of both combined (general + oral) wellness services. While such events will non solve the dental and full general health needs of all Maryland residents, it is important to empathise the part that an initiative such as MOM can play in addressing the overlapping chronic conditions such every bit diabetes with oral diseases. This assessment challenges the states to consistently examine how nosotros develop and implement these public health events and how we design their affiliated services. This will allow for streamlining future operations, and tailoring this type of forum with its related health disinterestedness activities for more effective follow-upwards and on-going care after a MOM event has ended. In the absence of a comprehensive policy solution to the oral health crunch, nosotros take a moral obligation to alleviate human suffering with temporary solutions like MOM events. Given the frequency of Mission of Mercy dental clinics and the continued demand for the charitable services they provide, we must design them in a fashion with a shared vision to eliminate oral health disparities and achieve health equity.

Abbreviations

HEF:

Wellness Disinterestedness Festival

IRB:

Institutional Review Board

M-CHE:

Maryland Center for Wellness Equity

MOM:

Mission of Mercy

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Acknowledgements

Nosotros would like to thank the MOM attendees who willingly gave of their valued time to participate in this important work. We thank Ms. Shawnta Jackson for her role in organizing the Health Equity Festival. The authors would also similar to thank the Agents of Change (AOC) Writing Group in the Maryland Center for Wellness Equity for their support.

The funding agencies had no role in the report blueprint, analysis, or interpretation of the data, writing of the report, or in the decision to submit the article for publication. Equally a result, the content is solely the responsibleness of the authors and does not necessarily correspond the official views of the National Establish on Minority Wellness and Health Disparities nor the National Institutes of Health.

Funding

This study was supported by Award Number P20MD006737 (Sandra C. Quinn and Stephen B. Thomas, PIs) from the National Institute on Minority Wellness and Health Disparities. Craig S. Fryer was supported in role, through his Mentored Inquiry Scientist Development Award to Promote Diverseness (K01CA148789; PI). Mary A. Garza was supported in part, through her Mentored Research Scientist Development Accolade to Promote Multifariousness (K01CA140358). James Butler Iii was supported in part, through his Mentored Career Evolution Laurels to Promote Diversity (K01CA134939). Drs. Thomas, Quinn, Passmore, Jackson, and Ms. Jackson were supported in part by the Eye of Excellence in Race, Ethnicity, and Health Disparities Enquiry grant from the NIH'south National Institute on Minority Health and Health Disparities (NIMHD, Honour Number 5P20MD006737, Thomas & Quinn, PIs).

Availability of data and materials

All information used to conduct these analyses are stored within the University of Maryland's School of Public Health's secure server. Request for admission to the information should be fabricated to the respective writer and will be considered.

Author information

Affiliations

1. Maryland Heart for Health Equity, School of Public Health, University of Maryland, 4200 Valley Bulldoze, College Park, Md, USA

   Devlon N. Jackson, Susan Passmore, Craig S. Fryer, Jie Chen, James Butler III, Mary A. Garza, Sandra C. Quinn & Stephen B. Thomas

2. Department of Health Services Administration, School of Public Wellness, University of Maryland, 4200 Valley Drive, College Park, MD, USA

   Susan Passmore, Jie Chen & Stephen B. Thomas

3. Department of Behavioral and Customs Health, School of Public Wellness, Academy of Maryland, 4200 Valley Bulldoze, College Park, MD, USA

   Craig S. Fryer, Alice Yard. Horowitz, James Butler III & Mary A. Garza

4. Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, Md, USA

   Dushanka V. Kleinman & Alice M. Horowitz

5. Eye for Health Literacy, School of Public Health, University of Maryland, 4200 Valley Bulldoze, College Park, Doctor, USA

   Dushanka V. Kleinman

6. Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, USA

   Sandra C. Quinn

Contributions

DNJ, DVK, JC, CSF, SRP, and SBT contributed to drafting the manuscript. DNJ, JC, DVK, CSF, SBT contributed to the assay and estimation. SBT, SCQ, CSF, MAG, JB, SRP, DVK, and AMH contributed in the research blueprint. All co-authors contributed in the review and editing for important historical and administrative content. All authors read and canonical the final manuscript.

Corresponding author

Correspondence to Devlon North. Jackson.

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The University of Maryland Institutional Review Board (IRB) determined our examination of the de-identified dataset did not crave IRB approving for a secondary information analysis.

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Not applicative.

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The authors declare that they have no competing interests.

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Jackson, D.N., Passmore, Southward., Fryer, C.S. et al. Mission of Mercy emergency dental clinics: an opportunity to promote full general and oral health. BMC Public Health eighteen, 878 (2018). https://doi.org/ten.1186/s12889-018-5792-z

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• Received: 04 January 2018

• Accustomed: 04 July 2018

• Published: 13 July 2018

• DOI : https://doi.org/ten.1186/s12889-018-5792-z

Keywords

• Public health
• Community health, emergency dental clinics
• Health equity
• Oral health
• Mission of mercy

Do We Have Dental Service In Mercy Hospital,

Source: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5792-z

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