Preventive Dental Care Use Research Articles

The effects of dental hygienist autonomy on dental care utilization.

We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use with the 2001-2014 Medical Expenditure Panel Survey. We measure the strength of autonomy regulations by extending the Dental Hygiene Professional Practice Index to the years 2001-2014, allowing us to capture changes in regulations within states over time. Using a difference-in-differences framework applied to selected states, we find that relaxing supervision requirements to provide dental hygienists moderate autonomy results in an increase in total dental visits due to greater use of preventive dental care. However, the use of dental treatment decreases when states adopt the highest level of autonomy. Both sets of estimates increase in magnitude when we subset the sample to dental care provider shortage areas. In support of these findings, we show that dental visits shift to dental hygienists in shortage areas when states expand the scope of practice of hygienists, and that there is an increase in tasks performed by hygienists, such as cleanings and dental exams.

32-LB: Oral Care Behaviors among the U.S. Population with Diabetes

Diabetes self-care skills are necessary to control glucose in people with diabetes (PWD). The ADA recommends self-care behaviors including healthy eating, being active, monitoring, taking medication, consulting diabetes care professionals, and reducing risk for complications. Oral self-care is an important but often overlooked aspect of reducing risk in diabetes self-care. This study examined the relationship between diabetes self-care and oral care behaviors. Using NHANES 2011-2016, we analyzed data from 1,585 dentate adults (≥ 30yrs) with self-reported diabetes. Oral self-care was measured by use of preventive dental care in the past year and flossing frequency (never, 1-6day/week, daily). Descriptive analyses compared people reporting good diabetes self-care (score 4-7, summary score of 7 self-care recommendations) and those with poor diabetes self-care (score 0-3), an approximate median split. Sample weights were applied to derive US population estimates. Multivariable and multinomial logistic regression was performed adjusting for age, gender, race, education, income and health insurance. Among the US PWD, 35% report daily flossing and 29% report never flossing; 48% reported a preventive dental visit in the past year. PWD who performed good diabetes self-care were 47% more likely to report using preventive dental care compared to those with poor diabetes self-care (AOR=1.47, 95%CI 1.18-1.84), and they were 38% more likely to be flossing daily (AOR=1.38, 95%CI 1.07-1.79). PWD who practice good diabetes self-care are more likely to also engage in good oral self-care. However, the association cannot be attributed to diabetes self-management education because until 2023, the ADA standards for diabetes self-management did not address oral health practices or dental care. Continued efforts are needed to incorporate oral self-care practices into diabetes self-care education. Further research is warranted to determine possible disparities in diabetes self-management and oral care. Disclosure Y. Zhang: None. S. Leveille: None. K. Berger: None. S. M. Camhi: None. L. Shi: None.

Associations of health literacy with dental care use and oral health status in Japan

BackgroundThe concept of health literacy has gained prominence in the context of oral health. In Japan, curative dental care is generally under universal health coverage, while preventive dental care requires effort. We used this situation to test the hypothesis that high health literacy is associated with preventive dental care use and good oral health status, but not with curative dental care use, in Japan.MethodsA questionnaire survey was conducted from 2010 to 2011 among residents aged 25–50 years in Japanese metropolitan areas. Data from 3767 participants were used. Health literacy was measured using the Communicative and Critical Health Literacy Scale, and the total score was categorized into quartiles. Poisson regression analyses with robust variance estimators were conducted to examine the associations of health literacy with curative dental care use, preventive dental care use, and good oral health, adjusted for covariates.ResultsThe percentages of curative dental care use, preventive dental care use, and good oral health were 40.2%, 28.8%, and 74.0%, respectively. Health literacy was not associated with curative dental care use; the prevalence ratio (PR) of the highest relative to the lowest quartile of health literacy was 1.04 (95% confidence interval [CI], 0.93–1.18). High health literacy was associated with preventive dental care use and good oral health; the corresponding PRs were 1.17 (95% CI, 1.00–1.36) and 1.09 (95% CI, 1.03–1.15), respectively.ConclusionsThese findings may provide clues for the design of effective interventions to promote preventive dental care use and improve oral health status.

Health insurance is associated with dental care use among university students in Washington State

BackgroundThe goal of this study was to examine the association of health insurance and preventive dental care use among university students.MethodsThis secondary analysis of cross-sectional data focused on students at University of Washington in Washington state (WA) who completed a health insurance survey in 2017 (n = 3768). The exposure was health insurance (private insurance in WA [reference group], not insured, Medicaid or Medicare [public insurance], university insurance, private insurance not in WA, other) and the outcome was receiving a dental cleaning in the past 6 months. Logistic regression was used to generate odds ratios and 95% confidence intervals (CI) adjusted for confounders.ResultsAbout 5% of university students did not have health insurance and 37% did not have a dental cleaning in the past 6 months. Compared to students with private health insurance based in WA, the odds of not receiving a dental cleaning were 3.90 times greater for university students with no health insurance (95% CI 2.74, 5.55; p < .001) and 3.08 times greater for publicly-insured university students (95% CI 2.52, 3.76; p < .001).ConclusionsUniversity students are at risk for poor oral health behaviors. Those without health insurance and those with public insurance face barriers to preventive dental care. Efforts should be made to connect uninsured university students with insurance, dental services, and other oral health promotion activities.

Adverse Childhood Experiences and utilization of dental care: A cross sectional study of children in the United States

To examine the relationship between Adverse Childhood Experiences (ACEs) and utilization and delay of dental care among children. Using data from the 2018–2019 National Survey of Children's Health (n = 53,963) we examined the association between ACEs and 1) dental health; 2) use of dental care; 3) use of preventive dental care; 4) delaying needed dental care. Logistic regressions were used to calculate odds of each outcome, with nine ACEs and the cumulative number of ACEs as the independent variables each in separate models. After accounting for confounders, most ACEs were associated with higher odds of having poorer dental health. Similarly, most ACEs were associated with lower odds of using dental care and higher odds of delaying needed dental care. This study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that dental care is also adversely impacted. Efforts must be undertaken to improve access to dental care for children with a history of ACEs.

Does preventive dental care reduce nonpreventive dental visits and expenditures among Medicaid-enrolled adults?

To determine whether preventive dental visits are associated with fewer subsequent nonpreventive dental visits and lower dental expenditures. Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resource File. A repeated measures design with individual and year fixed effects examining the relationship between preventive dental visits (PDVs) and nonpreventive dental visits (NPVs) and dental expenditures. Not applicable. Of 28,152 adults (108,349 observation-years) meeting inclusion criteria, 36.0% had a dental visit, 27.8% a PDV, and 22.1% a NPV. Compared to no PDV in the prior year, at least one was associated with fewer NPVs (β=-0.13; 95% CI -0.12, -0.11), lower NPV expenditures (β=-$29.12.53; 95% CI -28.07, -21.05), and lower total dental expenditures (-$70.12; 95% -74.92, -65.31), as well as fewer PDVs (β=-0.24; 95% CI -0.26, -0.23). Our findings suggest that prior year PDVs are associated with fewer subsequent NPVs and lower dental expenditures among Medicaid-enrolled adults. Thus, from a public insurance program standpoint, supporting preventive dental care use may translate into improved population oral health outcomes and lower dental costs among certain low-income adult populations, but barriers to consistent utilization of PDV prohibit definitive findings.

Evaluation of an Oral Health Management Project in Connection to a Non-Communicable Disease Prevention and Management Project: A Case Study in South Korea.

This study aimed to develop, pilot, and evaluate a three-year integrated preventive management project focused on chronic diseases and oral health prevalence. A total of 1148 users of the health care office of the G Public Health Center with dental risk factors were selected for this study and connected to the dental counseling department. Respondents were classified into a group that would receive counseling-type self-education on oral care and a second group that needed dental care. To evaluate the dental care utilization and satisfaction, a telephone survey was conducted with the 263 people. Oral health behavioral changes were analyzed in 97 comparable subjects who responded to both the oral health basic survey and telephone survey. More than 90% of the subjects who visited the dental clinics were positively satisfied with the system for requesting care and with being referred to dental clinics at the public health center or community dental clinics. Measures of oral health perception and of behavior need showed positive changes. This study was effective in inducing positive changes in the oral health management behavior of chronically ill patients and in promoting the use of preventive management-centered dental care.

Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services.

To examine whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid. Medical Expenditure Panel Survey (2011-2016), Area Health Resources File, and Medicaid adult dental coverage policies. We conducted a quasi-experimental analysis using linked parent-child dyads in low-income families (≤125 percent of the Federal Poverty Level). We assessed whether expansions of Medicaid to low-income adults under the Affordable Care Act were associated with increases in the use of preventive dental services among low-income children when state Medicaid programs did vs did not cover these services for adults. Over the study period, 37.8 percent of low-income children received at least one annual preventive dental visit. We found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered (1.26 percentage points; 95% CI: -3.74 to 6.27) vs did not cover preventive dental services for adults (3.03 percentage points; 95% CI: -2.76 to 8.81). (differential change: -1.76 percentage points; 95% CI: -8.09, 4.56). However, our estimates are imprecise, with wide confidential intervals that are unable to rule out sizable effects in either direction. We did not find an association between Medicaid expansions with concurrent coverage of preventive dental services for adults and children's use of these services. Factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.

Does covering routine dental care for the Medicare population produce cost savings in Medicare? A preliminary 2-year analysis.

We estimated the association between the use of preventive dental care and medical use and expense for older persons over a 2-year period to determine if a Medicare dental benefit for routine care could result in potential cost savings in Medicare. We relied on 2008-2014 Medical Expenditure Panel Survey data to estimate separate logistic and lognormal ordinary least squares regressions to analyze the influence of year 1 preventive dental care on either year 1 or year 2 use and expenses for total health care, office-based care, outpatient care, inpatient stays, emergency department visits, and prescription drugs. Our findings provide evidence over a 2-year period that a Medicare dental benefit for routine care could produce an increase in office-based visits and expense. We also found that older persons currently using routine dental care have healthier lifestyles and greater access to care and use of preventive medical care than current nonusers. Our results affirm the need for a longer-term study to provide any conclusive evidence as to the ultimate impact of a Medicare dental benefit on other health care use and expenses.

Facilitating Green Supply Chain in Dental Care through Kansei Healthscape of Positive Emotions.

Dentistry is highly energy- and resource-intensive with a significant environmental impact. To consolidate green dentistry supply chains, delivering the care of highest quality that meets client value should not be neglected. This study emphasized the importance of client-centered healthscape design for facilitating a green dentistry supply chain. A client-centered healthscape design, which promotes clients’ positive emotions and increases willingness to revisit the dentist, plays a critical role in realizing green dentistry supply chains in the long run. For this purpose, the relationship among dental healthscape design elements, client emotions, and revisit intentions was investigated using a Kansei engineering-based approach. The effects of dental healthscape elements on clients’ positive emotions and the effects of positive emotions on clients’ revisit intentions were holistically examined on the basis of the stimulus–organism–response model. Through this approach, 17 elements of design, ambience, and social interaction factors that comprise the dental healthscape and 20 Kansei words used to express clients’ positive emotions regarding dental service were identified. A questionnaire survey was used to assess Kansei and revisit intention in healthscape scenarios, composed of varied design elements. Primary data were collected from 600 individuals from 2017 to 2018 throughout Taiwan. Partial least squares was applied to holistically analyze the effects of dental healthscape elements on clients’ positive emotions and the effects of positive emotions on clients’ revisit intention to generate a Kansei model for the dental healthscape. All 20 Kansei words had significant positive effects on the dental revisit intention of clients. The five positive emotions most associated with increased revisit intention were thoughtful, hopeful, tender, comfortable, and cozy. The Kansei model of the dental healthscape provides references for healthscape design that maintains positive client emotions during the dental service and results in high revisit intention. This approach can realize an emotion-centered design for dental healthscapes that promotes preventive dental care, early treatment, and effective use of medical resources, and consequently contributes to green dentistry supply chains.

Associations of social relationships with curative and preventive dental care use among young and middle‐aged adults: Evidence from a population‐based study in Japan

Social relationships are important for diffusion of information and behaviours. Access to preventive dental care is more difficult than access to curative dental care under the Japanese universal healthcare system. Our objective was to examine whether social relationships were differentially associated with curative and preventive dental care use in Japan. A questionnaire survey was conducted between 2010 and 2011 among residents aged 25-50years in Japanese metropolitan areas. Valid responses were obtained from 1919 men and 2207 women. Social relationships included social networks (membership of organizations and number of close ties) and social support (informational support and instrumental support). Poisson regression analyses with robust variance estimators were conducted to examine associations between each social relationship variable and curative dental care use or preventive dental care use, adjusted for covariates. While 38.4% of men and 42.0% of women used curative dental care, 22.9% of men and 32.5% of women used preventive dental care in the past year. No measures of social relationships were associated with curative dental care use among men and women, except the number of close ties among men. By contrast, all measures of social relationships were associated with preventive dental care use among men; the multivariate-adjusted prevalence ratios (95% confidence intervals) of the highest compared with the lowest level of social relationships were 1.58 (1.18-2.13) for membership of organizations, 1.58 (1.24-2.00) for the number of close ties, 1.41 (1.10-1.82) for informational support and 1.30 (1.01-1.68) for instrumental support. Among women, no measures of social relationships were associated with preventive dental care use. Social relationships were associated with preventive dental care use among men but not among women, while these were not associated with curative dental care use.

Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program

BackgroundPreschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state’s Access to Baby and Child Dentistry (ABCD) program. MethodsThe authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child’s special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios. ResultsOf the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care. ConclusionsCSHCN who were enrolled in Medicaid in Washington’s ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid. Practical ImplicationsFuture intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.

Preventive Dental Care Utilization in Asian Americans in Austin, Texas: Does Neighborhood Matter?

Although dental care is an essential component of comprehensive health care, a substantial proportion of the U.S. population lacks access to it. Disparities in dental care are most pronounced in racial/ethnic minority communities. Given the rapid population growth of Asian Americans, as well as the growing attention of neighborhood-level effects on health care use, the present study examines how individual-level variables (i.e., age, gender, marital status, ethnicity, education, place of birth, length of stay in the U.S., dental insurance, and self-rated oral health) and neighborhood-level variables (i.e., poverty level, density of Asian population, dentist availability, and Asian-related resources and services) contribute to predicting the use of preventive dental care in a sample of Asian Americans in Austin, TX. This study adds to the growing literature on the effect of neighborhood-level factors on health care as sources of disparities. Those living in the Census area with higher level of available dentists were more likely to use preventive dental care services. Findings suggest the importance of the location (proximity or accessibility) to dental clinics. In a planning perspective for health care policy, identifying the neighborhood with limited healthcare services could be a priority to diminish the disparity of the access.

Disparities in Receipt of Preventive Dental Services in Children From Low-Income Families

Healthy People 2020 includes a goal of increasing use of preventive dental care among children from low-income families. The services used to define preventive care are evidence-based services (i.e., dental sealants and professionally applied topical fluoride) and professional dental cleaning, which lacks evidence of effectiveness in preventing caries. This study examined how increasing preventive dental care use and reducing disparities by race/ethnicity among children from low-income families varied by the services included in case definitions of preventive dental care use. Three case definitions of past-year preventive dental care use were considered: (1) the Healthy People 2020 definition; (2) receipt of an evidence-based caries prevention service; and (3) dental cleaning only. Using pooled data from the 2001-2002 and 2013-2014 Medical Expenditure Panel Survey for each definition, this study conducted in 2017 used multivariate logistic regression to estimate changes in preventive dental care use among children from low-income families by race/ethnicity. Use increased for all racial/ethnic groups for all definitions. Use of preventive dental care (Healthy People 2020 definition), however, was at least two times higher than evidence-based preventive dental use for all racial/ethnic groups in both survey periods. After controlling for insurance status and parental education, the disparity between non-Hispanic black and non-Hispanic white children in use of preventive dental care that was present in 2001-2002 was not detected in 2013-2014 whereas the disparity for evidence-based preventive dental care use persisted. Case definitions of preventive dental care that include non-evidence-based services may overstate receipt of effective preventive dental care and reductions in certain racial/ethnic disparities.

Conditional Cash Transfers And Health Of Low-Income Families In The US: Evaluating The Family Rewards Experiment.

Opportunity NYC-Family Rewards was the first conditional cash transfer, randomized controlled trial for low-income families in the United States. From 2007 to 2010, Family Rewards offered 2,377 New York City families cash transfers that were conditional upon their investments in education, preventive health care, and parental employment. Their health and other outcomes were compared to those of a control group of 2,372 families. The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care. It improved parents' perception of their own health and levels of hope, mainly through improvements in reported financial well-being. While the program's impacts on physical health were weaker, our study might not have captured effects on chronic disease risk that take longer to accrue. In the context of New York City's operating social-safety-net programs, conditional cash transfers may have led to positive, albeit modest, improvements in the health of poor families.

Vaccine and Preventive Dental Care Use Prevalence in Young Children

Vaccine and Preventive Dental Care Use Prevalence in Young Children

Caregiver Burdens and Preventive Dental Care for Children with Autism Spectrum Disorder, Developmental Disability and/or Mental Health Conditions: National Survey of CSHCN, 2009-2010.

Objective The purpose of this study is to examine the burdens of caregivers on perception of the need and receipt of preventive dental care for a subset of children with special health care needs-children with Autism Spectrum disorder, developmental disability and/or mental health conditions (CASD/DD/MHC). Methods The authors used the 2009-2010 National Survey of CSHCN. The survey included questions addressing preventive dental care and caregivers' financial, employment, and time-related burdens. The associations of these burdens on perceptions and receipt of preventive dental care use were analyzed with bivariate Chi square analyses and multinomial logistic regressions for CASD/DD/MHC (N=16,323). Results Overall, 16.3% of CASD/DD/MHC had an unmet preventive dental care need. There were 40.0% of caregivers who reported financial burden, 20.3% who reported employment burden, and 10.8% who reported time burden. A higher percentage of caregivers with financial burden, employment burden, and time-related burden reported that their CASD/DD/MHC did not receive needed preventive dental care (14.1, 16.5, 17.7% respectively) compared to caregivers without financial, employment, or time burdens (9.0, 9.6%, 11.0% respectively). Caregivers with financial burden (adjusted multinomial odds ratio, 1.38 [95% CI 1.02, 1.86] and employment burden (adjusted multinomial odds ratio, 1.45 [95% CI 1.02, 2.06] were more likely to report that their child did not receive preventive dental care despite perceived need compared to caregivers without financial or employment burdens. Conclusions for practice Unmet needs for preventive dental care were associated with employment and financial burdens of the caregivers of CASD/DD/MHC.

Dental utilization for Medicaid-enrolled children with cystic fibrosis.

Despite a multitude of risk factors, children with cystic fibrosis (CF) have lower reported dental caries prevalence. A potential explanation is preventive dental care use, but no studies to date have examined dental use for children with CF. Iowa Medicaid data were analyzed for children age 3 to 17 years (N = 156,268). Poisson regression models were used to compare utilization rates for any dental care and also for specific categories of dental care, by CF status. Children with CF were significantly less likely to use any dental care than children without CF (incident rate ratio: 0.819, 95% CI: 0.80 to 0.84, p < .001). There were no significant differences in use across specific categories of dental care. Medicaid-enrolled children with CF are less likely to use dental care than children without CF. These findings suggest that use of dental care use is an unlikely explanation for lower purported caries rates among children with CF.

Preventive dental care in older adults with diabetes

BackgroundThe association between poor oral health and diabetes is well documented. Preventive oral health care is, therefore, strongly indicated for people with diabetes. The authors conducted a study to determine if there was a difference in preventive dental care use among older adults with diabetes in 2002 and in 2011 and to compare preventive dental care use by older adults with and without diabetes in 2002 and in 2011. MethodsThe authors used a data sample of participants from the Medicare Current Beneficiary Survey that included older (65 years and older) fee-for-service Medicare beneficiaries. The key outcome was self-reported preventive dental care. In 2002, there were 8,725 participants; in 2011, there were 7,425 participants. The authors conducted χ2 and logistic regression analyses. ResultsIn 2002, 28.8% of participants with diabetes had preventive dental care. In 2011, this percentage increased to 36.0%. Similar results were seen among participants without diabetes (42.9% in 2002 and 45.5% in 2011). The increase in preventive dental care was statistically significant for participants with and without diabetes. The participants with diabetes, as compared with participants without diabetes, remained statistically less likely to have had preventive dental care in adjusted logistic regression analysis with and without considering the interaction between observation year and diabetes (adjusted odds ratios, 0.73 and 0.86, respectively). ConclusionsAlthough the percentage increase in participants with diabetes receiving preventive dental care is welcomed, older adults with diabetes continue to have substantial preventive dental care needs. Practical ImplicationsAdditional efforts are needed to encourage people with diabetes to obtain preventive dental care.

Income gradients in oral health according to child age.

This study aimed to confirm whether the well-known income disparities in oral health seen over the life course are indeed absent in 9- to 11-yr-old children, and to explore the role of access to dental care in explaining the age-profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1-5, 6-8, 9-11, 12-14, and 15-17yr), using survey logistic regression to control for family-, parental-, and child-level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9- to 11-yr-old children. Different age-patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9- to 11-yr-old children, was also seen in 15- to 17-, 12- to 14-, and 6- to 8-yr-old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9- to 11-yr-old children. Access to dental care could attenuate income gradients in oral health in other age groups.