Dental Coverage Research Articles

Dental Coverage for Medicare Beneficiaries.

Poor oral health has been associated with various systemic diseases (e.g., endocarditis, pneumonia, cardiovascular disease, and diabetes) and decreased quality of life. When enacted in 1965, Medicare excluded coverage for comprehensive dental services. As of 2023, Medicare has allowed coverage of limited dental services inextricably linked to specific medical conditions. Many Medicare Advantage plans (Medicare Part C) offer dental coverage. Yet in 2019, approximately 24 million Medicare beneficiaries (47% of all Medicare enrollees), lacked dental coverage. Seventy-one percent of traditional Medicare enrollees (those not enrolled in a Medicare Advantage Plan) reported that high cost was the primary reason that they did not obtain dental care. The importance of oral health for the older adults has been the main reason that a national interprofessional consortium, which includes several national nursing organizations, has been advocating for legislation to expand Medicare to include dental coverage. The consortium's efforts have been thwarted by fierce opposition from the American Dental Association and many Republican legislators. Given the vital role that nurses and advanced practice nurses play in caring for the nation's older adults and disabled, nursing's voice needs to be strengthened as leaders in advocating for inclusion of dental benefits in traditional Medicare.

Analysis of the utilization rate of claimed dental implants and related factors.

Purpose: This study aims to identify the utilization of claimed dental implants and the related factors in South Korea using the Anderson behavioral model.Materials and Methods: This study used the Health Checkup Cohort DB, claimed data from the National Health Insurance Service (NHIS), to identify changes in the utilization of dental implants and related factors. The study population was selected as 75 years old because they were covered by NHIS since the first year, 2014. Finally, the sample subjects in the analysis were 63,880. The data was analyzed using IBM SPSS Statistics for Windows, version 26.0 (Statistical Package for the Social Sciences 26.0. SPSS Inc. Chicago, IL, USA).Results: The dental implant utilization rate of the study population increased continuously, from 3.4% in Phase 1 to 6.3% and 7.0% in Phase 2 and 3, respectively. The significant differences by region, insurance type, and disability were shown in Phases 1 and 2 (p<0.05), but it was insignificant in Phase 3 (p>0.05). In the fully adjusted logistic regression model, the probability of using dental implants was 1.9 times higher in the higher Phase than the others. The people who had annual oral examinations showed a two times higher possibility of having dental implant surgery.Conclusions: It is necessary to review the recent claiming trends and related factors before the decision-making for coverage, especially dental coverage with huge effects, such as dental implants.

The New Medicare Dental Benefit—Small but Mighty

This Viewpoint details the previous lack of dental coverage under Medicare and what the new expansion could provide for patients now and in the future.

A Comparison of Nationwide Dental Utilization and Medicaid Dental Coverage

Background: In 2020, Medicaid provided health and long-term care coverage to 72,995,197 adults aged 18-64 in the United States. While Medicaid broadly covered medical services, dental benefits were limited in many states. This study aims to examine the relationship between state-level differences in adult Medicaid dental coverage and access to oral health care, using oral health metrics from the Centers for Disease Control and Prevention (CDC). Methods: We conducted a retrospective analysis of data from the official Medicaid website, which outlined dental procedures covered in each state. Dental attendance for individuals aged 18 and older, based on income, was obtained from the Behavioural Risk Factor Surveillance System (BRFSS) for the period of January to December 2019. Authors analysed dental visits across three income groups: Group A (<$15,000), Group B ($15,000-$24,000), and Group C (>$50,000). Each dental procedure covered by Medicaid was assigned a value of '1,' resulting in a 'Total Score' for each state (ranging from 0-13). States were then grouped into categories based on their Total Scores: 1-4, 5-8, and 9-12. Scores of '0' and '13' were analysed separately. Authors found that Groups A and B visited the dentist less frequently than Group C, suggesting a correlation between income, dental coverage, and access to care. Result: This study examined the relationship between state-level Medicaid benefits and access to Oral Health care, demonstrating a direct relationship between Medicaid coverage in each state and overall access to dental services in the same state. Conclusion: Expanding Medicaid dental coverage for various procedures will enhance accessibility to dental care and ultimately protect oral health.

Analysis of Dental-related Emergency Department Utilization in Michigan

Objective: Emergency departments (ED) are critical to the United States healthcare system. However, they are known to be inefficient environments to deliver definitive care including management of dental emergencies. ED’s may also serve as an inadvertent, but important, stop gap for individuals who lack dental coverage. The nation’s healthcare system continues to struggle with inadequate resources to provide dental care for vulnerable patients who disproportionately suffer from dental-related conditions. Method: This study is an analysis on dental-related ED utilization in the state of Michigan. The authors collaborated with the Michigan Health & Hospital Association who provided data from the Michigan Inpatient and Outpatient Database for dental-related hospital emergency department (ED) visits in Michigan hospitals during 2018-2019. University of Michigan Medical School’s committee on human subjects’ research reviewed the protocol and provided IRB exemption (HUM00192629). Results: State funded Medicaid (33%) and federally funded Medicare (33%) were the most common payer types for patients with dental-related conditions who reported to Michigan ED’s from 2018 to 2019. Charges per ED encounter was the highest for Medicare, $2,900-$3,200, and lowest for other payers, $1,300-$1,500. Charges for ED-inpatient per encounter were the highest for Medicare ($22,000-$24,000). The age range for which patients most frequently presented to the emergency department (ED) was 25-64. However, expenses per encounter for patients 65 and older were roughly two to three times higher than for patients in other age ranges. Conclusion: The study revealed a disproportionately higher percentage of patients who identified as Black presented to Michigan emergency departments (30%) with a dental-related emergency.

Cost-effectiveness of expanding national health insurance coverage for composite resin restorations in cancer patients in South Korea

ObjectivesCancer patients often have compromised oral health, making them vulnerable to severe dental caries and restoration failures. Due to the nature of cervical or anterior caries in cancer patients, the use of adequate restorative materials is important. However, public dental insurance coverage for composite treatments varies among countries and only glass ionomer cements (GICs) are covered in all age groups in South Korea. This study examined the cost-effectiveness of expanding national health insurance coverage to include resin composite (RC) restorations as compared with GIC in cancer patients. MethodsData from cancer patients who received direct restoration using GIC were identified from the National Health Screening Cohort. The relative effect of RC compared to GIC was determined through a meta-analysis, which was then utilized in calculating corresponding transition probabilities within a multi-state model. A Markov-chain Monte Carlo microsimulation was performed to estimate useful life-years and total treatment costs at the tooth level. The incremental cost-effectiveness ratio (ICER) of RC versus GIC was calculated, considering scenarios with and without expanded national health insurance coverage. The robustness of the results was confirmed through various sensitivity analyses. ResultsBetween the two materials, RC resulted in a 0.4-year longer useful life. From a limited societal perspective, it cost $9.6 less with expanded coverage but $24.3 more without expansion, resulting in an ICER of -$25.2 and $63.9 per tooth-year, respectively. From a patient's perspective, the ICER values were -$72.7 versus $138.8 per tooth-year, respectively, translating into $200 more in savings with the expansion. Various sensitivity analyses consistently demonstrated a smaller ICER when insurance coverage was expanded. ConclusionsThe expansion of national health insurance coverage to include RC restorations for cancer patients appears to be clearly cost-effective. This emphasizes the need for further policy considerations to ensure access to dental care for cancer patients. Clinical SignificanceTimely management of dental caries is crucial for cancer patients, as untreated caries can escalate into severe oral conditions, negatively impacting treatment outcomes and increasing care costs. Expanding a national health insurance coverage for cancer patients in the treatment of early dental lesions is necessary to prevent advanced dental diseases.

The Effects of the Expansion of Dental Care Coverage for the Elderly.

Expanding dental care coverage for the elderly is globally recommended but not widely implemented due to its high costs and intangible benefits. This study examined the impact of such an expansion in Korea using the imputation-based method proposed by Borusyak et al. We analyzed data from the Korea National Health and Nutrition Examination Survey (2007-2019) on dental service utilization and chewing ability among older adults. The policy resulted in a 13.5% increase in partial denture use and a 60.5% increase in dental implants among those aged 65 and above. These changes corresponded with reductions in severe chewing difficulty by 23.3% and 13.0%, respectively. No significant changes were observed in full denture use. The price elasticity of demand for partial dentures and dental implants was estimated to be -0.19 and -0.86, respectively. These findings underscore the critical role of affordability in enhancing the utilization of dental implants among the elderly and highlight the importance of appropriately expanding dental insurance coverage to improve oral health outcomes in this population.

Remoteness-attributable financial inequality in dental service utilization in Australian older adults: A Blinder-Oaxaca decomposition.

Oral health is often overlooked in ageing health issues, despite its impact on overall health and quality of life. Older Australians, especially those in rural and remote areas, face difficulties accessing oral health services. The aim of the study was to investigate the factors that contribute to financial barriers to accessing dental services among the ageing population in Australia in relation to their residential location. The study included a weighted sample of Australian adults aged 65 years and over from a population-based survey called the National Study of Adult Oral Health (NSAOH) conducted in 2017-18. Descriptive analysis was conducted and generated cross-tabulation tables to investigate the distributions of the outcome, exposure and covariates, including Sex, Education level (the highest level of education), Equivalised household income, Dental insurance, Concession card ownership, Difficulty paying a dental bill and last dental visit. Blinder-Oaxaca decomposition counterfactual analysis was used to explore the potential impact of a person's residence on their financial difficulty accessing dental services. The findings showed that 26.2% (95% CI: 24.3-29.3) of major city residents and 30.1% (95% CI: 26.9-33.3) of rural residents avoided or delayed dental visits due to cost. The decomposition analysis indicated that 53.8% of the disparities in the prevalence of avoided or delayed dental visits due to cost were explained by the selected variables, while 46.2% remained unexplained. The explanatory variable with the largest contribution was difficulty paying a $200 dental bill, accounting for 62.4% of the differences, followed by dental insurance, last dental visit and equivalised household income, which explained 42.1%, 20.8% and 14.9% of the differences, respectively. Regional/remote populations experience more financial barriers to accessing dental care than major city populations and the identified factors explain a significant proportion of these disparities. Based on the study findings, recommendations include expanding public dental service coverage, evaluating concession card mechanisms and advocating for regular dental visits to mitigate disparities in dental care access.

Street dentistry: A commentary on Canada's new dental coverage and expansion opportunities for dental schools, health agencies, and not-for-profit.

Street dentistry: A commentary on Canada's new dental coverage and expansion opportunities for dental schools, health agencies, and not-for-profit.

Awareness and attitude towards dental coverage right affecting the dental service utilization among selected thais in Bangkok

Oral health problems are one of the most prevalent public health issues in Thailand. However, the rate of dental service utilization is relatively low despite having three major healthcare coverages provided for Thai citizens. Objectives: This study aims to investigate whether awareness about dental coverage affects the rate of dental care utilization and the attitude towards dental coverage compared across coverage types. Methods: A cross-sectional analytical study based on Bangkok, Thailand using a newly developed questionnaire to assess socio-demographic information, dental healthcare utilization, dental coverage, and attitude towards dental coverage. Convenience sampling was used. Population studied was Thai citizens of working age (above 15 years old). Paper-based questionnaire forms were handed out in public venues. Data was analyzed with chi-square analysis to assess whether the sociodemographic characteristics and awareness of dental coverage correlates with dental care service utilization. Logistic regression was used for multivariate analysis to determine which variables had more influence upon dental care utilization. ResultsA total of 315 participants were included for data analysis. Chi-square analysis showed that gender, age, occupation, education, income, and awareness of dental coverage and reported type of dental coverage were all significantly correlated to dental healthcare service utilization (p-value <0.05). Multivariate analysis revealed that gender, age, career, and income still affect utilization when put into a logistic regression model, while awareness was no longer significant in predicting utilization rate. ConclusionIn conclusion, sociodemographic factors that significantly affect dental care service utilization included age, gender, occupation, education and income. When weighted with other socioeconomic determinants of dental care utilization, awareness of dental coverage schemes did not have a significant prediction value.

The development of a novel bidirectional fine-tuning mandibular advancement device

ObjectiveTo develop a novel mandibular advancement device (MAD) with high comfort, good compliance, and bidirectional fine-tuning capability for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and to evaluate the therapeutic efficacy of the new MAD.MethodsThe MAD, featuring upper and lower dental splints with a fine-tuning mechanism for mandibular adjustment, incorporates improved design elements such as partial dental coverage, shortened baffles, and memory resin lining. The novel MAD was used to treat 30 OSAHS patients in the study, comparing pre- and post-treatment scores on the Epworth Sleepiness Scale (ESS), the Apnea-Hypopnea Index (AHI), and the lowest oxygen saturation (LSO2).ResultsThe novel MAD reduced size and side effects, enhancing comfort. All patients complied well, using it for an average of 95% over 30 days and ≥ 5 h nightly. After treatment, significant improvements were observed in ESS, AHI, and LSO2 (P < 0.05).ConclusionsThis novel bidirectional adjustable MAD provides high comfort and compliance, improving treatment precision. It is an effective choice for mild to moderate OSAHS patients and an alternative for those intolerant to CPAP or averse to surgery.

Limosilactobacillus reuteri and Its Probiotic Potential against Cariogenic Bacteria

Bacteriotherapy is a promising option in addressing dental caries, a persistent global public health challenge with multifactorial origin, including dysbiosis. Despite the exploration of various probiotics, outcomes remain inconclusive. Objective: This study aimed to assess the inhibitory potential of L. reuteri and other potential probiotics like S. salivarius and S. oralis on the growth, adhesion, colonization, and viability of major cariogenic pathogens, comparing their probiotic efficacy. Methods: An in vitro experimental study was conducted, encompassing direct competition assays in solid and liquid co-culture tests and the characterization of adhesion to dental enamel and cell viability by life or death assay. Results: L. reuteri exhibited the significant inhibition of S. sobrinus and S. mutans growth in both solid and liquid cultures, with statistically notable differences. Scanning electron microscopy and confocal microscopy demonstrated reduced cariogenic biofilm formation when combined with L. reuteri, corroborated by diminished bacterial viability and decreased dental enamel coverage. These findings underscore L. reuteri’s potential as an effective agent in caries prevention. Conclusion: The study suggests L. reuteri could serve as an effective probiotic in bacteriotherapy against dental caries. It displayed substantial inhibitory activity in vitro against cariogenic bacteria, impeding biofilm formation and adhesion, thereby impacting cell viability.

Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children.

The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. This national cross-sectional study used pooled2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83). Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.

Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged

BackgroundFor accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable.MethodsThis study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)].ResultsApproximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care.ConclusionIn the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.

Introduction to the Special Issue: Indigenous Self-determination in Health System Reforms

Across Canada, First Nations, Inuit and Métis peoples and communities live in rural, remote, Northern and reserve places, as well as urban places, and experience health inequities when compared with non-Indigenous peoples. These inequities are founded by pervasive colonial ideologies, policies, systems, and practices, many of which persist today resulting in multiple disparities in health as well as social, political, and economic areas (Adelson 2005; Allan and Smylie 2015). In Canada, the federal government’s role in the provision of health services is primarily through the limited public health and prevention services offered by the First Nations and Inuit Health Branch (FNIHB), now Indigenous Services Canada (ISC). Services are offered to status (registered) First Nations living on-reserve and to Inuit living in their traditional territories. They provide non-insured health benefits (NIHB) such as prescription drugs, dental, and vision coverage to all status/registered First Nations and Inuit, regardless of where they live; however, non-insured health benefits are not offered to Métis or non-status First Nations. As a result of historical legislative vagueness, and the multiplicity of authorities that has resulted, the First Nations, Inuit and Métis legislation and health policy framework is very complex, which itself results in a great deal of diversity in health service provision across provinces and territories. The framework fails to adequately address the health care needs of the Métis or First Nations and Inuit people who are either not registered or not living on reserve or in their traditional territory (Lavoie and Gervais 2012). [continued in PDF / HTML]

Race, Ethnicity, and Other Barriers to Access Dental Care During Pregnancy.

Historically, women of color showed poorer oral health and lower dental service utilization in the USA. These barriers to dental care during pregnancy included dental coverage, primary language, dental provider availability, safety concerns, affordability of dental care, and perceived oral health benefits during pregnancy. The purpose of this study is to examine whether race/ethnicity modified the associations between barriers to accessing dental care and dental service utilization during pregnancy. This cross-sectional study sample included 62,189 women aged 20 and older with a recent birth history in 21 states from the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019. We introduced a race/ethnicity by barrier interaction term to our multiple logistic regression models. After adjusting for other confounders, dental insurance during pregnancy and perceived oral health benefits were associated with 4.0- and 5.6-fold higher odds, respectively, of dental service utilization during pregnancy. Statistically significant effect modification by race/ethnicity was observed in crude and adjusted analyses of the relationship between dental service utilization for all barriers included in the interaction analyses with all adjusted p-values < 0.001. The interaction analysis found that racial/ethnic disparity in visiting dentists during pregnancy was significant among women who reported these dental barriers. In contrast, such racial/ethnic disparity was substantially attenuated among women who did not report such barriers. The observed racial/ethnic disparities could be mitigated by such supporting mechanisms: dental coverage, provider availability and willingness to treat pregnant women, oral health education on the safety of dental care during pregnancy, and affordable dental care costs.

How an increase in income affects the use of dental care services among a low-income population: evidence from the Finnish basic income experiment

BackgroundPrevious research has shown that the use of dental care services has a significant socioeconomic gradient. Lower income groups tend to use dental care services less, and they often have poorer dental health than higher income groups. The purpose of this study is to evaluate how an increase in income affects the use of dental care services among a low-income population.MethodsThe study examines the causal effect of increasing cash transfers on the use of dental care services by utilizing unique register-based data from a randomized field experiment conducted in Finland in 2017–2018. The Finnish basic income experiment introduced an exogenous increase in the income of persons who previously received basic unemployment benefits. Register-based data on the study population’s use of public and private dental care services were collected both for the treatment group (N = 2,000) and the control group (N = 173,222) of the experiment over a five-year period 2015–2019: two years before, two years during, and one year after the experiment. The experiment’s average treatment effect on the use of dental care services was estimated with OLS regressions.ResultsThe Finnish basic income experiment had no detectable effect on the overall use of dental care services. However, it decreased the probability of visiting public dental care (-2.7% points, -4.7%, p =.017) and increased the average amount of out-of-pocket spending on private care (12.1 euros, 29.8%, p =.032). The results suggest that, even in a country with a universal public dental care coverage, changes in cash transfers do affect the dental care patterns of low-income populations.

Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System.

This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.

Exploring the Challenges in Covering Dental Services through Complementary Insurance in Iran: A Qualitative Study.

Financial protection is crucial for attaining universal health coverage. The inclusion of costly dental services in insurance plans poses a significant challenge for all parties involved in the insurance sector. This study aimed to investigate the challenges of covering dental services by complementary insurance in Iran during 2020-2021. This qualitative research was conducted in Iran during 2020-2021. A triangulation of methods and data sources were employed to achieve a comprehensive perspective. In-depth semistructured interviews were conducted on an individual basis, and all national documents, rules, regulations, and instructions pertaining to complementary dental insurance were thoroughly reviewed. Purposeful sampling was used to select participants from all stakeholder groups engaged in dental insurance coverage, including (1) health system policymakers, (2) insurers, (3) policyholders, (4) care providers (dentists), and (5) insured people. Six open-ended questions were formulated to explore various facets of dental insurance, including (1) development, (2) management, (3) population coverage, (4) premium calculation, (5) services coverage, and (6) payment and reimbursement mechanisms. With the consent of the participants, all interviews were recorded and transcribed verbatim. The gathered data were evaluated using a framework analysis approach in the MAXQDA20 software. Finally, the primary themes, each encompassing multiple subthemes, were identified and presented. A total of 26 interviews were conducted with five groups of interviewees, and nine national documents were evaluated. Six themes were extracted, which included 18 codes from the interviews and seven codes from the documents. The extracted themes were as follows: (1) Insurance commitments and service coverage, (2) reimbursement system, (3) information system, (4) economic issues, (5) population coverage, and (6) regulation and supervision. The high cost of dental services was the most frequent challenge, followed by the insurance commitments and service coverage. The delivery of dental services through complementary insurance in Iran primarily faces economic and service coverage challenges. The resolution hinges on the collaboration between basic and complementary insurance sectors, the development of a unified information system for insured individuals, and the implementation of a risk-adjusted premium plan.

Life course social mobility, race and tooth loss in adulthood: The role of dental health services.

To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults. In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0. The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities. This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.