Determinants of oral health care utilization among diverse groups of immigrants in New York City

BackgroundFew studies have examined utilization of oral health care services among immigrants. The authors examined the determinants of utilization of oral health care among a diverse group of immigrants in New York City.MethodsThe authors examined and interviewed 1,417 foreign-born people, aged 18 to 65 years, who were residents of New York City. They conducted examinations by using criteria established by the National Institute of Dental and Craniofacial Research, Bethesda, Md. The authors used unconditional logistic regression to estimate odds ratios (ORs) and 95 percent confidence intervals for having visited a dentist within the previous year for each of the independent variables.ResultsMore than 70 percent of the participants lacked dental insurance and only about 31 percent reported that they had visited a dentist within the previous year. Flossing (OR = 1.18), dental insurance (OR = 1.58), having a regular source of dental care (OR = 4.76) and more filled teeth (1.33) were independent predictors of utilization of services.ConclusionsHaving a regular source of dental care and having dental insurance are important predictors of immigrants' utilization of oral health care services in New York City.Clinical ImplicationsThe study results suggest the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of vulnerable populations.     

The Influence of Dental Insurance on Institutionalized Older Adults in Ranking Their Oral Health Status

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel‐Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as “good,”“very good” or “excellent” by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting “good,”“very good” or “excellent” oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.     

Determinants of dental care visits among low-income African-American children

BACKGROUND: The objective of the authors' analysis was to investigate the determinants of dental care visits among young, low-income African-American children. METHODS: Trained researchers interviewed a representative sample of low-income black families (caregivers and children aged 0 through 5 years) in Detroit to assess their dental visit history, dental insurance status and oral health behaviors. Dental examinations were conducted using the International Caries Diagnosis Assessment System (ICDAS). Of the 1,021 families who completed an interview and examination, a subset of the 552 children aged 3 to 5 years (and their primary caregivers) was the focus of this analysis. RESULTS: Children with private dental insurance had four times higher odds of having visited a dentist compared with those who had no dental insurance, and the odds for children receiving Medicaid were about 1.5 times higher. A child's age and a caregiver's educational attainment were positive and significant determinants of child dental visits. Caregivers who visited a dentist for preventive reasons were five times more likely to have taken their children to visit the dentist. Visiting a dentist was associated with an increased mean number of filled or missing tooth surfaces, but it was not significantly associated with the mean number of untreated decayed teeth. CONCLUSION: Children's dental insurance status was a significant determinant of their having visited a dentist. Even after the authors accounted for insurance status and other risk indicators, they found that children of caregivers who reported visiting a dentist for preventive care had a higher number of dental care visits. Determinants of caregivers' preventive dental visits must be identified and encouraged to improve the percentage of low-income children who visit dentists.     

Income, dental insurance coverage, and financial barriers to dental care among Canadian adults

Objectives: To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults. Methods: Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: “In the past three years . . . has the cost of dental care been a financial burden to you? . . . have you delayed or avoided going to a dentist because of the cost? . . . have you been unable to have all of the treatment recommended by your dentist because of the cost?” Results: The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out‐of‐pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage. Conclusions: Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability.     

Predictors of dental care utilization among working poor Canadians

Abstract – Objective: This study used the Gelberg–Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians. Methods: A cross‐sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked ≥20 h a week, were not full‐time students and had annual family incomes <$34 300. A pretested questionnaire included sociodemographic items, self‐reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits. Results: Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25–34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self‐rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001). Conclusions: This study identified predisposing and enabling vulnerabilities that jeopardize the dental care‐seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults.     

Adult Dental Visits in California: Successes and Challenges

OBJECTIVES: This study sought to estimate and characterize the proportion of California adults who visited a dentist in the preceding year and to identify reasons for not going. METHODS: In 1995, 4,029 adults were interviewed by telephone as part of the California Behavioral Risk Factor Surveillance System. Items included recentness of a dental visit, dental insurance status, and number of teeth lost due to disease. Persons who had not seen a dentist within the preceding year were asked the main reason they had not gone. RESULTS: In 1995, 65.9% of adults reported visiting a dentist in the preceding twelve months. Use of dental services was greater among persons aged 35 years or older (70.4%) than among those aged 18-34 years (58.4%) and among those with dental insurance (74.9%) than those without (54.4%). Dental visits were less likely among adults living at or below 200 percent of the federal poverty level, those with less than a high school education, and the edentulous. Reasons most commonly cited for not seeing a dentist were no perceived reason to go (37.2%), cost (30.7%), and fear (9.2%). CONCLUSION: Substantial variation in use of dental services exists among California's adults. Achieving equity in access and opportunity for disease prevention in this state may require expanded dental insurance coverage and serious efforts in oral health promotion.     

A Profile of Black and Hispanic Subgroups'' Access to Dental Care: Findings from the National Health Interview Survey

This study examined which black and Hispanic minority subgroups were least likely to obtain dental care and why, based on logistic regression analyses of the 1986 National Health Interview Survey. Blacks and Hispanics were less apt to have private dental insurance coverage, to be knowledgeable about the purpose of fluoride, to have been to a dentist in the past year, and, when they did go, were more apt to have gone in response to symptoms rather than for preventive reasons, compared to whites. Logistic regression analyses for adults 18 years of age and older and for children and adolescents 2 to 17 years of age showed that the following individuals had the lowest probability of having been to a dentist in the past year: males, members of larger families, adults who were unemployed or in blue-collar jobs, those who lived in the South or nonmetropolitan areas, people who perceived their health to be fair or poor, and those with no private dental insurance. Mexican-Americans were least likely to have been to a dentist regardless of their income or education. In general, the findings confirmed the importance of dental insurance, as well as suggesting a need for more school-based dental programs and public health clinic-based dental health education and outreach efforts for targeting minority children and adults.     

The influence of the volume of dental treatment on change in self‐reported oral health

Objectives: To find an association between self‐reported change in oral health and dental treatment volume. Methods: Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004‐06 and 12‐month follow‐up data from service use logbooks and mail self‐complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate‐ and multivariate‐adjusted relationships. Results: One‐eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n = 176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P = 0.01), having a treatment need (P < 0.01), usually visiting a dentist for a problem (P < 0.05), and having a lot of difficulty paying a $100 dental bill (P = 0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P < 0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check‐up was significantly associated with improvement in oral health (P < 0.01). Conclusion: Having six or more dental services was significantly associated with a greater self‐reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.     

Oral health care utilization by US rural residents,National Health Interview Survey 1999

OBJECTIVE: To compare the dental care utilization practices of rural and urban residents in the United States. METHODS: Data on dental care utilization from the 1999 National Health Interview Survey for persons 2 years of age and older (n=42, 139) were analyzed by rural/urban status. Percentages and 95 percent confidence intervals were calculated to produce national estimates for having had a visit in the past year, the number of visits, reasons given for last dental visit and for not visiting a dentist, unmet dental needs, and private dental insurance. RESULTS: Rural residents were more likely to report that their last dental visit was because something was "bothering or hurting" (23.3% vs 17.6%) and that they had unmet dental needs (10.1% vs 7.5%). Urban residents were more likely to report having a dental visit in the past year (57.7% vs 66.5%) and having private dental insurance (32.7% vs 37.2%), compared to rural residents. There were no significant differences in most reasons given for not visiting the dentist between rural and urban respondents. CONCLUSION: Dental care utilization characteristics differ between rural and urban residents in the United States, with rural residents tending to underutilize dental care.     

Parents' perspectives on a dental home for children with special health care needs

The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.     

Dental service utilisation among adults in a European developing country: findings from a national health survey

Background: The objective was to estimate the frequency of visits to a dentist and to assess the impact of determinants on dental care utilisation among adults in the Republic of Srpska (RS), Bosnia and Herzegovina. Methods: We conducted a cross-sectional study using data from the 2010 National Health Survey performed in the RS. A total of 4,128 adults (≥18 years) were interviewed in their homes. Multivariate logistic regression was used to assess the relationship between demographic characteristics, socio-economic characteristics, health behaviours, self-rated health, self-reported noncommunicable diseases (NCDs) and dental care utilisation. Results: Only 20% of all respondents reported a visit to a dentist in the year preceding the interview. Younger respondents (OR = 0.97), women (OR = 1.30–1.39), urban dwellers (OR = 1.41–1.61), those who were employed (OR = 1.20) and those who self-reported NCDs (OR = 1.32–1.33) more frequently utilised dental services. The opposite was true for those in the low wealth index group (OR = 0.79), persons with a low (OR = 0.31) and middle (OR = 0.48) level of education and people who self-rated their health as average (OR = 0.76–0.80). Conclusion: The present study revealed a low frequency of visits to a dentist, especially for preventive oral health care. It also confirmed demographic, socio-economic and health-related differences in dental-care utilisation in RS. To minimise those differences, systemic approaches aimed at increasing access to dental care could be an important step. Oral health-promotion policies need to be adopted in the RS.Key words: Oral health, dental services, socio-economic status, adults, Republic of Srpska     

Access to dental care by young South Australian adults

BACKGROUND: Despite reported concern over the dental care of young adults little research has been done on their use of dental services in Australia. The aim of this study was to investigate the patterns of dental utilization of young South Australian adults aged 20-24 years. METHODS: A random sample of 2300 young adults was selected from the electoral roll. Partial or complete addresses and possible phone numbers were obtained for 1921 persons. Telephone interviews were conducted for 1261 subjects to obtain information on socio-demographics, health behaviour and dental visiting (response rate 65.6 per cent). RESULTS: One third of young adults (34 per cent) had not made a dental visit in the previous two years and 38 per cent usually visited for a problem rather than a check-up. Making a dental visit in the last two years was significantly associated with a number of socio-demographic variables including age and gender, with holders of private dental insurance and those who have not avoided care because of cost having higher odds of making a visit and males and government concession card holders having lower odds of visiting. Usual reason for visiting a dentist for a problem was significantly associated with no private dental insurance, holding a government concession card, no tertiary education and avoiding care because of cost. CONCLUSIONS: This study suggests that demographic and economic factors influenced use of dental services and reason for visiting of young South Australian adults.     

Attitudes toward dentists and the dental care system among the middle-aged and the elderly in Hong Kong

Abstract A sample of 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese were interviewed by trained interviewers using a structured questionnaire in an oral health survey conducted in 1991. The present analysis aimed to describe the dental-care-seeking behaviour and attitudes of these subjects. It was found that 43% of the younger and 23% of the older age group had visited a dentist within the past year. More than half of the elderly and a quarter of the adults had not been to a dentist for 3 yr or more, and the main reason given by these subjects was that they felt that nothing was wrong. The vast majority of the subjects consulted a dentist only when they had toothache or other dental problems. Less than 20% of the 35–44-yr-olds visited a dentist for a check-up or teeth cleaning, and these subjects were described as having a prevention-oriented attitude toward oral care. The result of a logistic regression analysis showed that there was a higher chance for subjects to have this attitude if they had dental programme coverage, perceived their teeth to be good, had better dental health knowledge, had a more positive dental attitude, and were less anxious about dental care. However, the influence of these factors was quite weak, because the overall percentage of correct classification of the model was 83.7% and the sensitivity was only 23.3%.     

Dental care use in Ontario: the Canadian community health survey (CCHS)

Background

Oral health is a significant measure of overall health, and regular dental visits are recommended for the maintenance of oral health. The purpose of this study is to determine the pattern (amount and type) of, and factors associated with dental care use among Ontarians.

Methods

Data from the 2014 cycle of the Canadian Community Health Survey was used and analysis was restricted to individuals aged 12 and above residing in Ontario. Dental care use was defined by two distinct outcomes: not visiting a dentist within the past year and visiting a dentist only for emergencies. Multivariable logistic regression was performed to examine the association between socio-demographic, health behavior, oral health, and other health-related factors and the two outcomes.

Results

More than a quarter of participants reported not visiting the dentist in the last year, and 19% reported usually visiting a dentist only for emergencies. Multivariable logistic regression analysis suggested that males, individuals of Aboriginal status, those with low educational attainment, low household income, no dental insurance, who smoked, less frequent teeth brushing, poor health of teeth and mouth, or had diabetes were at a significant increased likelihood of not visiting the dentist within the past year, and only visiting a dentist for emergency care.

Conclusions

Socioeconomic status, self-reported oral health, and general health behaviors were associated with dental care use. These findings highlight the need for focusing efforts toward improving dental care use among Ontarians.

     

Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study

OBJECTIVE: To investigate the association between routine visits for dental checkup and self-perceived oral health. METHODS: Cross-sectional data from a study of university employees in Rio de Janeiro - The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire. RESULTS: Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good ('very good', 'good' or 'fair') individuals who reported self-perceived oral health as bad ('bad' or 'very bad') were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental 'checkup'. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68-5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51-4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77-2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss. CONCLUSIONS: Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental 'checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public policies it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.     

北京某社区15岁以上居民口腔卫生服务利用情况及影响因素

目的 了解北京社区居民中不同人群口腔卫生服务利用情况,并分析其相关影响因素,以期为今后口腔卫生服务的发展提供依据.方法 采取多阶段整群随机抽样的方法,抽取北京市新街口社区街道居民进行家庭健康询问和健康检查的入户调查,统计分析社区居民口腔卫生服务利用的影响因素.结果 调查社区居民2003户,共计4459人.社区居民1年内口腔就诊率为11.3%(502/4459).Logistic结果显示青年人(OR=2.072)、有医疗保障(OR=2.835)、就诊距离近(OR=3.535)、有就诊意愿(OR=2.595)以及认为自己口腔健康差(OR=2.014)是有利于社区居民口腔卫生服务利用的主要因素.结论 社区居民口腔卫生服务利用率较低,中老年人尤为严重.应提高居民对口腔疾病的认识和对口腔卫生服务的了解,同时完善医疗保障体系.

Abstract：

Objective To investigate the utilization of oral health services and to analyze the factors associated with oral health services for the community residents. Methods Household health interview and oral health condition survey were conducted to obtain information about oral health services. The respondents were recruited by a multi-stage random cluster sampling procedure. Multiple dummy regression analyses were performed for the assessment of the relative effect of behavioural factors on dental attendance. Results A total of 2003 families, 4459 people participated in this study. The people seeking dental treatment accounted for 11.3% (502/4459) per year. Young people ( OR = 2. 072), having medical insurance system ( OR =2. 835 ), short distance to see dentist ( OR = 3. 535 ) , oral health awareness ( OR = 2. 595 ) , poor selfassessment of oral health status (OR =2. 014 ) were the main factors which influenced dental attendance of community residents. Conclusions The utilization of oral health service was low, particularly for middleaged people and the elderly. Oral health education and medical insurance system should be strengthened.     

北京市城乡居民口腔医疗服务利用与费用分析

目的 对北京市城乡居民口腔医疗服务利用和费用进行定量研究，为口腔医疗保障制度的制定提供依据。方法 采用分层、整群、随机抽样方法抽取城区人口1517人，农村人口1878人，利用人户调查方式进行口腔医疗服务利用和费用的调查。结果 城乡居民口腔疾病就诊率均处于较低水平，但次均费用较高。农村居民就诊率为城区居民的1／3，次均费用约为城区居民的1／2。农村居民口腔费用支出占年收入的2．07％，城区居民为1．77％。不同人口、社会经济学背景的人群费用支出差异有显著性。结论 北京市居民的口腔医疗费用水平较高，在收入中占相当比重，并且农村居民的费用负担要重于城区居民。本研究中所调查的费用水平可为北京市口腔医疗保险覆盖提供一定参考依据。     

Determinants for dental visit behavior among Hong Kong Chinese in a longitudinal study

OBJECTIVES: The aim of this research was to study the major determinants for dental services utilization among middle-aged Hong Kong Chinese in a longitudinal study using an expanded Andersen and Newman model as the theoretical framework. METHODS: A random sample of 372 middle-aged Hong Kong Chinese were interviewed and clinically examined in an oral health survey. The findings were explained to the subjects and they were advised to seek care from their own dentist as appropriate. RESULTS: A total of 322 subjects were interviewed over the telephone after 12 months. About half had visited a dentist within the study period. Results of the bivariate analysis showed that proportionally more subjects who had dental benefit coverage, had prevention-oriented attitudes, were regular users of dental services, had received counseling from a dentist, or had more filled teeth at the baseline examination had visited a dentist within the study period. Logistic regression analysis produced a final model consisting of seven factors and three interaction terms that was able to classify 68 percent of the subjects into the correct user category. CONCLUSION: The expanded Andersen and Newman model was useful as a theoretical framework in studying the dental services utilization behaviors of the Hong Kong adults.     

Determining dental checkup frequency.

BACKGROUND: The authors assessed the dental checkup frequency of adults living in the Detroit tricounty area and identified demographic, access and subjective factors associated with visits to a dentist made not because of a dental problem. METHODS: Data are from a 1994 probability-based sample of adults who were interviewed and received an in-home oral examination. The authors used the variables of age, sex, education level, income level, dental insurance status, usual place for care, objective measures of oral health, and subjective assessments of health, pain and dental anxiety to predict the frequency of dental checkups. RESULTS: The authors found that differences in dental checkup behavior were related to demographics, access to dental care, subjective ratings of oral and general health and other self-assessments, and clinical parameters of oral health. In multiple logistic regression analysis considering all variables simultaneously, sex, income, having a usual place for care and level of dental care anxiety were found to be associated with having dental checkups. The authors determined the statistical significance level at P < .05. CONCLUSIONS: A total of 69.7 percent of the study population reported having had a dental checkup at least once a year in the past five years. The authors found that four factors associated with infrequent dental checkups: being male, having lower income levels, not having a usual place for care and being anxious about receiving dental care. PRACTICE IMPLICATIONS: Dental health professionals should consider the correlates of dental checkup frequency identified in this study and the usefulness of proposed strategies to increase and sustain regular preventive visitation patterns in their own patient populations.     

Dental insurance,attitudes to dental care,and dental visiting

Objective: Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self‐select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a “marker” for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes. Methods: Participants (South Australians aged 45‐54 years) of a 2‐year prospective cohort study (2005‐2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23‐item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors. Results: Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n = 529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted. Conclusion: Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a “marker” for predisposing attitudes.