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.     

An analysis of dental visits in U.S. children, by category of service and sociodemographic factors, 1996.

PURPOSE: Data from the 1996 Medical Expenditure Panel Survey were analyzed to determine the distribution of diagnostic and preventive, surgical, and other dental visit types received by U.S. children, aged 0-18 years. METHODS: Weighted point estimates and standard errors were generated using SUDAAN and stratified by age, sex, race/ethnicity, and poverty status. RESULTS: Overall, 39.3% of children had a diagnostic or preventive visit, 4.1% had a surgical visit, and 16.2% had a visit for a restorative/other service. Diagnostic and preventive services were most common, across age categories. For all types of service, utilization was higher among white and non-poor children, but there were no differences by gender. Age-specific associations were mixed, with diagnostic and preventive service and surgical service utilization having a different distribution than other service type. Poverty status was generally not associated with service-specific utilization among African-American children. CONCLUSIONS: There are profound disparities in the level of dental services obtained by children, especially among minority and poor youth. Findings suggest that Medicaid fails to assure comprehensive dental services for eligible children. Improvements in oral health care for minority and poor children are necessary if national health objectives for 2010 are to be met successfully.     

The association between low-socioeconomic status mother's Sense of Coherence and their child's utilization of dental care

da Silva AN, Mendonça MH, Vettore MV. The association between low‐socioeconomic status mother’s Sense of Coherence and their child’s utilization of dental care. Community Dent Oral Epidemiol 2011; 39: 115–126. © 2010 John Wiley & Sons A/S Abstract – Objectives: The objective of this study was to investigate the relationship of low‐socioeconomic status mother’s Sense of Coherence (SOC) and their child’s utilization of dental care services in a city of Southeast Brazil. Methods: A cross‐sectional study was conducted on a sample of 190 schoolchildren aged 11–12 and their mothers in Sao João de Meriti‐RJ, Southeast Brazil. The outcome variables were children’s use of dental care services and visiting dentists mainly for check‐ups. Demographic and socioeconomic characteristics and data regarding children’s dental care use were collected through interviews with mothers. Children’s oral health‐related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mother’s SOC was assessed through the validated short version (13‐item) of Antonovsky’s scale. Multiple logistic regression was used in the data analysis. Results: Of the mothers, 81.1% reported on their child’s utilization of dental care services. Of them, 42.9% considered check‐ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR = 2.08 95%CI = 1.17–3.64) and visit a dentist mainly for check‐ups (except for dental treatment) (OR = 2.02 95%CI = 1.06–3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, children’s oral health‐related behaviours and oral health measures. Conclusions: Mother’s SOC was a psychosocial factor associated with their child’s pattern of use of dental care services in low‐socioeconomic status families.     

Oral health status of older rural adults in the United States

BACKGROUND: Little is known about the oral health care of older rural residents. The authors describe oral health indicators for the older adult population by place of residence in the United States. METHODS: The authors analyzed data from the Third National Health and Nutrition Examination Survey and the 1995, 1997 and 1998 National Health Interview Surveys. Oral health indicators included perceived oral health (self-reported dental status and unmet dental needs) and dental status (untreated caries; decayed, missing and filled permanent teeth, or DMFT; and edentulism). Dental care utilization and access were measured by number of dental visits, frequency of dental visits and dental insurance status. RESULTS: Older rural adults were more likely than their urban counterparts to be uninsured for dental care (72.1 percent versus 66.1 percent, respectively) and were less likely to report dental visits in the past year (46.9 percent versus 58.4 percent, respectively). A higher proportion of rural residents than urban residents were edentulous (36.7 percent versus 28.2 percent, respectively) and reported poor dental status (50.7 percent versus 42.2 percent, respectively). There were no differences in unmet dental needs, percentage of people with untreated caries or in mean DMFT by place of residence. CONCLUSIONS: Older rural residents inadequately utilize dental care and have less favorable oral health indicators than do older urban residents. CLINICAL IMPLICATIONS: This article shows the need for more dental practitioners in rural areas. With the low density of dentists per person and the high need for care, rural America offers an excellent opportunity for oral health professionals to provide much needed services.     

Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan

Background  

HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors.     

Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs

Persons with special health care needs due to physical and cognitive impairment can be at increased risk for dental disease which can be attributed to, as well as exacerbate, existing medical conditions. This study assessed the nature of perceived barriers to obtaining oral health care among a special-needs population and the influence of these factors (in particular, fear and anxiety) on utilization of dental services. A total of 27.9% of the sample reported fear/anxiety about dental visits, with approximately half of those reporting to be very nervous or "terrified". There was an inverse relationship between the frequency of dental visits and the proportion of respondents reporting themselves as very nervous or terrified, and between the perception of oral health status and the level of dental fear/anxiety (P < 0.001). A large difference was reported between patient preference for pharmacologic modalities for anxiety control and those received at dental visits, with 40% of the youngest age group indicating that they would go to the dentist more frequently if sedation or general anesthesia were offered. The levels of self-reported fear/anxiety and the high proportion of respondents indicating an unmet need for adjunctive anesthesia services suggest that fear/anxiety acts as a barrier to dental care among this special-needs group which could be ameliorated with greater use of these services.     

Older Americans' access to oral health care

To determine whether older Americans have difficulty obtaining access to dental care, we studied 7,265 adults nationwide. The objectives of this analysis are to: (1) determine the proportion of older Americans receiving dental services, (2) identify the types of services received, and (3) examine barriers to access to dental care in this population. Almost half of the respondents over the age of 60 reported a dental visit in the past year. This is consistent with the national trend of increasing utilization of dental services by older adults in the United States. However, older respondents reported significantly fewer dental visits in the past year than respondents aged 25-59. The mean time since the respondent's last dental visit increased with increasing age. Minority elders and those older adults with lower incomes, lower educational achievement, poorer perceived health status, chronic diseases, transportation problems, and those living in rural areas had disproportionately fewer dental visits than more socially advantaged respondents. In multivariate analyses, less education, lower income, increasing age, and poorer self-perceived health status were identified as independent risk factors for not having a dental visit, suggesting that certain subpopulations of older Americans are at risk for not receiving necessary oral health services.     

The Relationship Between Dental Utilization and Preventive Participation Among a Well-elderly Sample

Previous studies have shown that dental utilization by older people is lower than for the general population. This study hypothesizes that an elder's tendency toward participating in preventive health activities may be an important factor in explaining the likelihood of accessing the dentist. Subjects included 1,911 older individuals who enrolled in the UCLA Medicare Screening and Health Promotion Trial. All were interviewed about their utilization of preventive health services and participation in preventive behaviors. A recent dental visit was positively associated with all sociodemographic variables examined except age and sex. It was also related to health status questions and utilization of the preventive health services and health behaviors studied. Logistic regression analysis showed that both summary preventive health behavior and preventive service utilization variables were important factors in explaining a recent dental visit (model chi-square/221.4, P=.001) along with income, not having a removable prosthesis, and perceiving the need for dental care. This study showed that dental utilization is related to older people's participation in other preventive activities. When in contact with older people, health care professionals should consider current oral and general preventive health status and encourage appropriate referral for preventive activities.     

The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome

OBJECTIVE: To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN: Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. SETTING: Two health authorities in South Wales, UK. SUBJECTS: A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. RESULTS: For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. CONCLUSIONS: Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.     

Comparison of utilization of dental care services among Chinese- and Russian-speaking immigrant elders

OBJECTIVE: The purpose of the study was to identify factors predictive of use of dental services among Chinese- and Russian-speaking immigrant elders. METHODS: The data for this analysis were collected from the 1997 survey "Assessing public health and health care needs of Russian-speaking elderly immigrants." A similar survey was replicated among Chinese-speaking elderly immigrants in 2000. Community-based samples of 300 Russian elders and 177 Chinese elders were recruited for the study. RESULTS: Chinese elders used dental care services at lower rates than Russian elders. Education, length of stay in the U.S., social support, and smoking behavior were significant predictors for the use of dental services among Chinese. However, among Russian elders, age, income, and denture use predicted utilization of dental services. CONCLUSIONS: Although Chinese- and Russian-speaking elders have similar immigrant experiences and share the same geographic location and urban setting, the two groups have different patterns of dental service use. These differences may be due to differences in socio-demographic characteristics, values, attitudes and knowledge of oral health and dental care, and unique cultural backgrounds.     

Use of children''s oral health services in Finland with special reference to heavy consumption

The consumption of oral health services among 4-16-yr-old children in Finland is described, including an analysis of heavy consumption. Data representative of all Finnish children were collected for 4518 children from municipal health centers and homes. The response rate was 85%. Children with orthodontic visits during the year were excluded from the analyses. Of the preschoolchildren 12% and of the school-age children 4% did not use any oral health services during the studied year. Non-users did not differ from the others in terms of socioeconomic status, distance to a health center or type of residential area. Public oral health services were used very unevenly. Half of the children consumed only one-fifth of the services and the next one-third used about one-third of the services. The heavy consumers, about one-fifth of the total, used as much as half of all the services. Among preschoolchildren, the heavy consumers were mainly from lower socioeconomic groups. In contrast, no clear predictive factors were found for heavy consumption among the schoolchildren. Heavy consumers had more both treated and untreated caries than the other children did. Their treatment was mainly restorative; at least half of them did not receive adequate preventive care. Finnish public oral health care clearly should make more efforts to ensure that heavy consumers of dental services do not remain so.     

Oral care needs, barriers and challenges among community dwelling elderly in New York State and northern Manhattan

Older adults are living longer and retaining their teeth, resulting in a concomitant increase in the need for oral care services. Despite improvements in oral health among the elderly, there continue to be profound disparities by race/ethnicity, socioeconomic and dentate status. Furthermore, challenges, such as limitations in activities of daily living, poor wheel-chair accessibility of dental clinics, poor geographic distribution of providers, difficulty navigating the oral health system and fiscal limitations make access to, and utilization of, dental services difficult among older adults. While dialogue around national policy, especially incorporation of dental benefits for adults in Medicare and Medicaid, is imperative, local efforts in New York and Northern Manhattan show promise in addressing the oral health and health care of older New Yorkers.     

Oral healthcare for elderly: identifying the needs and feasible strategies for service provision.

The aim of the present study was to assess the oral health practices, status and treatment needs of the rural elderly in national capital territory of Delhi. An effort was also made to identify patterns of utilization of dental services and test alternate strategies for service provision. A total of 96 elderly subjects (47 males and 49 females) in 5 rural areas were interviewed and clinically examined using Basic Oral Health Survey criteria of W.H.O. This was followed by a community trial in which the 5 villages were divided into control and test groups. Results of the survey found that both traditional as well as modern oral health practices co-exist in the rural community. Dental services were available to a majority (mostly through private sector), and edentulousness was a condition of primary concern among the elderly as a result of unmet treatment needs for dental caries and periodontal diseases. Age was a variable that was statistically significantly associated with edentulousness (p=0.005). Results of the community trial showed that higher utilization of care can be achieved by providing on-site dental care as compared to referring cases to tertiary care centers. Nevertheless provision of treatment alone is not a suitable policy recommendation since many elderly did not avail care even at on-site community dental health programmes that were operated free of cost. This emphasizes the need of health education over treatment in order to empower the elderly, especially the non-ambulatory patients, to practice prevention and develop favourable attitudes towards accepting prompt treatment at primary health care level.     

北京永定路社区居民口腔卫生服务需要和利用调查

目的了解北京社区居民口腔医疗需要和口腔卫生服务资源利用现况,为推动社区居民口腔医疗保健服务提供参考。方法以世界卫生组织口腔健康调查基本方法为标准,采用随机等比抽样调查方法,对北京永定路社区2 000名居民进行口腔健康检查和问卷调查,了解其口腔医疗需要情况及口腔卫生服务资源利用情况。结果共计1 845人的口腔健康调查表符合要求。其中254人(13.77%)不需要口腔医疗,864人(46.83%)需要择期口腔医疗,715人(38.75%)需要及早口腔医疗,12人(0.65%)需要紧急口腔医疗。社区居民1年内就诊率为39.73%。就诊选择国营口腔专科医院的占37.02%,选择私营口腔诊所的占35.88%。结论社区居民的口腔医疗需求普遍,口腔医疗保健任务艰巨,应加强社区口腔疾病预防控制工作。     

Use of dental service data to inform research and policy

Data collected routinely in dental care delivery systems could be used to inform research and policy. Projects in which data were collected with the help of general dental practitioners are outlined. In an EU-funded project, six partners collaborated to develop a methodology designed to establish links between characteristics of a health care system and health outcome, and to determine the characteristics of oral health care systems which promote oral health and those which are detrimental to oral health. The results indicated that the data collected in the different systems investigated varied enormously, and they could not be easily adapted to help in developing policy. A theoretical model was developed in which the production of oral health care was considered separately from the production of oral health. In the second example, the longevity of the restorations in a dental care delivery system in Ireland was investigated by routine service data.     

Shifts between use and non-use of dental services among young Danish adults over a 3-year period

Utilization of dental services among three groups of young adults was studied longitudinally. Each year from age 16 to age 19, participants were defined as users or non-users of alternative dental programs. Dental programs were taking place with public dental health service clinics (n = 386), with private dental practitioners, free of charge (n = 161), and with private dental practitioners, partially reimbursed by health insurance (n = 261). The paper analyzes whether the pattern of utilization of the last two groups might be described by a Markovian model defining use or non-use of dental care each of 3 years as two mutually exclusive Markovian states. Contingency table analysis of the relationships of the utilization status and sex, social group, and delivery program showed that the utilization pattern could not be described by a Markovian model. Conversely, strong relationships between 1-yr user status and 3-yr user status was found. Implications in relation to the prevailing dental health care policy emphasizing regular dental care and continuity between child dental health care and young adult dental programs are discussed.     

Expanding Health Insurance Coverage and the Implications for Dentistry

Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.     

Oral health status of a long-term-care, veteran population

Abstract – The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25–30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986–7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident. Soft tissue oral pathologies were rare and frequently related to prostheses use. The subject's overall willingness for care was high. Subjects were found to have a high number of medical comorbidities, and one third of all subjects had to be excluded from the periodontal examination for medical reasons or non-cooperation.     

Perceived oral health status,unmet needs,and barriers to dental care among HIV/AIDS patients in a North Carolina cohort: impacts of race

OBJECTIVE: This prospective observational study examined differences in perceived oral health status, treatment needs, dental care utilization patterns, and barriers to care between HIV-infected non-Hispanic blacks and whites in North Carolina. METHODS: 632 adult HIV-infected medical clinic attendees provided information on their oral health status and dental care history during face-to-face interviews with a trained interviewer. RESULTS: Compared to whites, blacks were significantly more likely to be female, older, less educated, have lower income, and have acquired HIV by heterosexual sex or injecting drug use. Although two-thirds of patients reported good oral health, blacks were significantly more likely to have loose teeth, need extractions, and be episodic dental care utilizers. Primary barriers to dental care were cost (30%), fear (19%), and low motivation (13%). Sixty-five percent of patients had unmet dental needs in the last three years. Race, cost, fear, and immune competence were significantly associated with unmet dental need in a multivariable model. CONCLUSIONS: Disparities exist within this HIV-infected population in oral symptoms, utilization patterns, and perceived unmet dental need. Targeted interventions that address barriers to care are needed to help establish preventive dental care patterns in this region, especially among blacks.