Use of dental services: an analysis of visits, procedures and providers, 1996

BACKGROUND: While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. METHODS: The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. RESULTS: Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. CONCLUSION: MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans.     

Dental services: use, expenditures and sources of payment, 1987

BACKGROUND: This article provides per capita estimates of dental care utilization, expenditures, mix of services and sources of payment for each of several socioeconomic and demographic categories. METHODS: The focus of the analyses presented here is on dental care utilization by the U.S. population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. CONCLUSIONS: These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. PRACTICE IMPLICATIONS: Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses, practitioners will be better positioned to meet the dental needs of all Americans.     

Private dental coverage: who has it and how does it influence dental visits and expenditures?

BACKGROUND: Dental insurance has had a significant impact on dentistry and dental care use. Dental insurance coverage may influence people's decisions to use dental care. During 1996, 42.9 percent of all dental expenditures were paid by private dental insurance. METHODS: The focus of this analysis is on private dental coverage, use and expenditures for the U.S. civilian community-based population during 1996. The authors provide national estimates for the population with private dental coverage, the population with a dental visit, mean number of dental visits per year and mean total expenditures for several socioeconomic and demographic categories during 1996, using Medical Expenditure Panel Survey, or MEPS, data. RESULTS: Poor and low-income people were less likely to have private dental coverage than were people with higher incomes. People without coverage at all income levels were less likely to report a dental visit than were people with coverage. When they controlled for coverage, the authors found that education at any income level did not appear to affect the likelihood of people's having multiple visits or higher expenditures. CONCLUSION: People with private coverage are more likely to visit a dentist, have a greater number of visits and have higher expenditures than are those without coverage. Private dental insurance coverage, however, is not the only determinant of dental care use. MEPS data also show that other factors play key roles. Comprehensive strategies designed to improve dental care use should keep each of these determinants in mind. PRACTICE IMPLICATIONS: While dentists may have a limited ability to influence people to seek care initially, they may be in a better position to influence the amount of care patients obtain, thereby helping make sure that patients receive the care that they need and want.     

Orthodontic dental visits during 1987 and 1996.

Americans underwent approximately 355 million dental procedures during 1987, approximately 8% for orthodontic treatment. Individual rates of utilization vary and are not uniform across the population. This article provides estimates of orthodontic utilization for each of several socioeconomic and demographic categories, using household data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). These data show that slightly more than 3% of the population, or approximately 39 million Americans, visited a dentist to receive orthodontic care nationwide during 1987 and 1996. For those with an orthodontic visit, the mean number of visits per patient decreased in number from 1987 to 1996.     

Characteristics of Patients Seeking Care from Independent Dental Hygienist Practices

Objectives : This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. Methods : New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. Results : Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. Conclusion : Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.     

Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons

BackgroundThe authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities.MethodsData were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix.ResultsA decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37).ConclusionsAlthough preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents.Practical ImplicationsThese results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients’ oral health needs.     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Does Dentistry as We Know It Have a Future?

The American Dental Association's Strategic Plan for the Future of Dentistry is primarily a self-serving document in that it attempts to protect the dentist regardless of the changing oral health needs of the population. Marketing, even if initially successful, will not increase the absolute demand for dental services, because persons on maintenance care require less care per year than sporadic users. Higher use will be balanced by less need. Excess supply creates incentive to overtreat. Today's dentist, as the dominant provider, does not have major motivation toward prevention, either by training or economic self-interest. The paper proposes that a modified hygienist, with more diagnostic training, should become the primary dental provider, with a better trained dentist as a secondary provider, combining problem solving and "surgical" skills. These changes would function best under a system combining group practice with a national health service.     

Caring for African-American patients in private practice: disparities and similarities in dental procedures and communication

OBJECTIVE. Disparities in oral health care among racial and low socioeconomic groups have been reported. The authors compared the communication behaviors and dental services to African-American and white patients in private dental offices. METHODS: and Subjects. The investigators directly observed office visits of 292 black and 1,552 white patients in 64 practices by using standardized checklists for the frequency of services provided and frequency and time of communication behaviors. From patient surveys, they constructed three communication scales and a patient satisfaction score. They examined the effects of provider-patient racial concordance on dental services and observed and perceived communication behaviors by using multiple regression analyses. RESULTS: Groups of black and white patients had similar demographic characteristics. Dental procedures were similar for black and white patients in offices with white providers. Compared with white patients, black patients with white providers reported lower ratings for how well the dentist knew them (P = .001), but patients' satisfaction with their providers was high and not affected by provider-patient racial concordance. After multivariate adjustment, odds of chatting were significantly lower between black patients and white providers than between racially concordant patients and providers (odds ratio = 0.38; P < .001), whereas odds of negotiation were lower among black patients regardless of the race of the provider. CONCLUSIONS: In this study sample, the investigators did not observe overt disparities in dental services on the basis of race. They noted that some communication behaviors were influenced by dentist-patient racial concordance, which suggests the possibility of more subtle disparities than usually are considered. CLINICAL IMPLICATIONS: Dental professionals could benefit from understanding their patients' perceptions of a range of interactions that occur during a typical dental visit.     

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.     

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life

OBJECTIVES?: The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services. METHODS?: A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P?≤?0.05). RESULTS?: The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. CONCLUSIONS?: Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist.     

The impact of income on children's and adolescents' preventive dental visits.

INTRODUCTION: Limited information is available on the effect of income level on whether people visit a dentist for preventive care, whereas more has been written regarding the effect of income on "any" dental visits--which may include emergencies. Also, little is known of the effects of "near-poor" income (101 to 200 percent of the U.S. federal poverty level) on dental visits and preventive dental visits. The authors examined the impact of income at the "poor" and "near-poor" poverty levels on preventive dental visits made by children and adolescents. METHODS: The authors used data from the 1996 Medical Expenditure Panel Survey for children and adolescents younger than 19 years of age to estimate the percentage of this group who had had preventive dental visits. They performed a multiple logistic regression analysis to adjust poverty levels by race and ethnicity, age and sex. RESULTS: The distribution of preventive dental visits for those who were poor was similar to that for those who were near-poor, but the percentage distribution of preventive visits for children and adolescents with higher income was significantly different from that for those in the lower income groups. This was true across all the variables considered. CONCLUSIONS: It is important to evaluate and monitor preventive care utilization trends for U.S. children and adolescents in the poor and near-poor categories separately, particularly in states that do not provide similar levels of access under the State Children's Health Insurance Program, or SCHIP. Enrollment of eligible children in Medicaid and SCHIP via oral health promotion outreach efforts, access to care and utilization of dental primary and secondary care services must be increased.     

Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants

Objectives: To assess the role of the individual determinants on the inequalities of dental services utilization among low‐income children living in the working area of Brazilian's federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil. Methods: A cross‐sectional population‐based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen's behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit. Results: Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables. Conclusions: The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low‐income children. The individual determinants seem to be important predictors of access.     

Assessing Patterns of Restorative and Preventive Care Among Children Enrolled in Medicaid,by Type of Dental Care Provider

BackgroundThe authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children.MethodsThe authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally.ResultsAmong the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers.ConclusionsThe study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care–only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.     

Role of the dental hygienist in the prosthodontic practice

Prosthodontic practices can benefit from the inclusion of a dental hygienist on the dental team. The dental hygienist can successfully complete procedures traditionally performed by the dentist. Delegation of these duties permits the dentist to spend time and energy on intricate procedures for which he or she has special expertise. The major modalities of responsibility that can be delegated include diagnostic data collection, educational and preventive services, and corrective therapy. It has been suggested that there is a need for expanding the duties of auxiliaries for prosthodontics in the future. It is our recommendation to use effectively the important auxiliary, the dental hygienist, in prosthodontic practice. For prosthodontic patients, the importance of the dental hygienist can be supported from two perspectives. First, the dental hygienist is formally educated in the oral and basic sciences and is qualified to perform intraoral procedures. Second, the dental hygienist is able to educate patients in regard to diet and oral hygiene habits. The dental hygienist's role in the prosthodontic practice has a potential that must not be overlooked. This opportunity, when provided, can be challenging, successful, and beneficial to the dentist, the patient, and the practice of prosthodontics.     

Validity of information concerning the use of dental services obtained in interviews

Two hundred and fifty-two persons out of a population of 358 were interviewed concerning their use of dental services. The validity of the information was tested by comparing the answers from each respondent with the contents of his/her dental treatment record. Replies to a question about the time interval since the last dental visit showed a high degree of validity. The validity of information concerning the type of treatment received at the last course of dental visits showed high validity for a single treatment and low validity when the treatment services were mixed. Responses about the regularity of treatment attendance demonstrated decreasing degree of validity with increasing number of dental visits during the last 5 years. The demographic and socioeconomic characteristics of the respondents showed little relation to the validity of their answers. However, the degree of validity decreased with increasing number of teeth.     

A comparison of dental services received by Medicaid and privately insured adult populations

BACKGROUND: Few studies have compared differences in dental care utilization rates between a publicly and a privately insured adult population in the same geographic area. The authors conducted this study to compare the demographic characteristics and use of dental services for enrollees in the Iowa Medicaid program and in the Delta Dental Plan of Iowa. The focus was on the overall use of dental services, with an emphasis on the use of tertiary care services such as endodontic therapy and tooth extraction services. METHODS: The authors used insurance claims data for adults aged 21 to 64 years who were enrolled in Delta Dental of Iowa and the Iowa Medicaid program for fiscal year 1998. They calculated utilization of dental services rates by type of dental procedure. RESULTS: In fiscal year 1998, 69.3 percent of Delta Dental enrollees and 27.2 percent of Medicaid enrollees had a dental visit. More than 90 percent of those in both populations with a dental visit had used preventive dental services during the year. Medicaid users were nearly twice as likely as Delta Dental enrollees to receive endodontic therapy (9.9 percent versus 5.0 percent, respectively) and nearly four times as likely to have had a tooth extracted (27.4 percent versus 7.1 percent, respectively). CONCLUSIONS: Privately insured enrollees were more likely to use dental services that were Medicaid enrollees. The greater use of tertiary care services by the Medicaid population than by the privately insured population is indicative of a lower oral health status for this group at the time they sought care, even though it was a much younger group of adults. PRACTICE IMPLICATIONS: The oral health status of low-income adults enrolled in Medicaid could benefit greatly from higher use of routine preventive dental services and earlier treatment of oral diseases to prevent the substantial need for preventable tertiary care services.