Abstract
ObjectivesWe aimed to assess periodontal services utilization in very old Germans.MethodsA comprehensive sample of very old (≥ 75 years), insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed periodontal service provision, entailing (1) periodontal screening index (PSI), (2) periodontal status/treatment planning, (3) periodontal therapy (scaling and root planning with or without access surgery), (4) postoperative reevaluation, and (5) any of these four services groups. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) diagnoses-related groups was explored.Results404.610 individuals were followed; 173,733 did not survive follow-up. The mean (SD) age was 81.9 (5.4) years. 29.4% (119,103 individuals) utilized any periodontal service, nearly all of them the PSI. Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54–1.57%, or 6224–6345) of individuals. The utilization of the PSI increased between 2012 and 2017; no such increase was observed for treatment-related services. Utilization decreased with age; those aged > 85 years received nearly no services at all. Decreases were more pronounced for treatment-related services. Utilization was lower in rural than urban areas, those with hardship status, and those severely ill (e.g., dementia, heart insufficiency). In multivariable analysis, a previous PSI measurement tripled the odds of receiving treatment-related services (OR: 3.2; 95% CI: 3.0-3.4).ConclusionsPeriodontal services utilization was low. Screening for periodontal disease significantly increased therapy provision. Social, demographic, regional, and general health aspects were associated with utilization.Clinical significanceThe utilization of periodontal services in the very old in Northeast Germany was low, and even screening was only performed in a minority of individuals. Policies to increase identification and management of periodontitis especially in the most vulnerable individuals are needed.
Highlights
While general improvements in oral health in high income countries have clearly benefitted the majority of children and adults, indicated by fewer restored or missing teeth [1, 2], the same is not true for older adults
Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54–1.57%, or 6224–6345 individuals)
Given the expected morbidity growth in this age group, mainly via morbidity compression, and given that this age group itself is growing, such analysis seems warranted, even more as so the utilization in this group is affected by multiple factors, like age, gender, general health, social status, and place of living [12, 13]
Summary
While general improvements in oral health in high income countries have clearly benefitted the majority of children and adults, indicated by fewer restored or missing teeth [1, 2], the same is not true for older adults This group of individuals oftentimes retains a higher number of teeth into higher age, but concomitantly suffers from a higher number of coronal and root caries lesions as well as periodontally affected teeth. For the older individuals, it is likely that a range of further factors determine the utilization and provision of periodontal services These may encompass age, general health, financial means, and place of living, all of which affect the accessibility of services. We demonstrated that both the overall consumption of any service and the consumption of specific services are associated with such factors
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