Use of specific dental treatment procedures by dentate adults during a 24-month period

Frequency and type of tooth extractions in adults vary by age: register-based nationwide observations in 2012-2017

OBJECTIVE

This register-based study assessed the frequency of and age-specified variation in tooth extractions in adults visiting private dentists in Finland in 2012-2017.

MATERIAL AND METHODS

Retrospective study design was used on the register-based data of private sector services. Data of the entire 6 years, 2012-2017, included records of a total of 6,252,039 patients. From among these, further detailed information was gathered in 2012 for 1,058,305 patients, and in 2017, for 985,043 patients. For each 6 years, the data were aggregated into patients' 5-year age groups that were observation elements. Proportions of patients undergoing oral surgical treatments were compared during the 6 years 2012-2017, and details of tooth extractions in 2012 and 2017. Linear regression modelling was used to analyse thinkable age- and year-related inclinations in oral surgical treatments.

RESULTS

Across the 6 years, a total of 848,362 patients (13.6%) underwent oral surgical treatments, and the rates varied by year 13.3-13.8%. By age group, the smallest rates (9-10%) were for 35-49-year-olds and greatest (20-22%) for those aged below 25 or over 84. The rates in same-age groups were stable. In 2012 and 2017, mean numbers of tooth extractions per patient by year were 0.17 and 0.18, and per patients undergoing oral surgical treatments, 1.29 and 1.27, respectively. Proportion of patients undergoing oral surgical treatments and mean number of tooth extractions per patient was greater in younger and older age groups.

CONCLUSIONS

Tooth extractions in adults are age-dependent and age-specified differences remain stable across the years.

Racial/ethnic disparities in provision of dental procedures to children enrolled in Delta Dental insurance in Milwaukee, Wisconsin

OBJECTIVES

Most studies on the provision of dental procedures have focused on Medicaid enrollees known to have inadequate access to dental care. Little information on private insurance enrollees exists. This study documents the rates of preventive, restorative, endodontic, and surgical dental procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI) in Milwaukee.

METHODS

We analyzed DDWI claims data for Milwaukee children aged 0-18 years between 2002 and 2008. We linked the ZIP codes of enrollees to the 2000 U.S. Census information to derive racial/ethnic estimates in the different ZIP codes. We estimated the rates of preventive, restorative, endodontic, and surgical procedures provided to children in different racial/ethnic groups based on the population estimates derived from the U.S. Census data. Descriptive and multivariable analysis was done using Poisson regression modeling on dental procedures per year.

RESULTS

In 7 years, a total of 266,380 enrollees were covered in 46 ZIP codes in the database. Approximately, 64 percent, 44 percent, and 49 percent of White, African American, and Hispanic children had at least one dental visit during the study period, respectively. The rates of preventive procedures increased up to the age of 9 years and decreased thereafter among children in all three racial groups included in the analysis. African American and Hispanic children received half as many preventive procedures as White children.

CONCLUSION

Our study shows that substantial racial disparities may exist in the types of dental procedures that were received by children.

Uso regular de serviços odontológicos entre adultos: padrões de utilização e tipos de serviços

O objetivo deste estudo foi avaliar o uso regular de serviços odontológicos entre adultos, identificando grupos nos quais esse comportamento é mais freqüente. O estudo foi realizado em Pelotas, Rio Grande do Sul, Brasil, com desenho transversal de base populacional, envolvendo 2.961 indivíduos, que responderam um questionário estruturado. A prevalência de uso regular encontrada foi de 32,8%. Estiveram positivamente associadas ao uso de forma regular as seguintes características: ser do sexo feminino, ter idade < 60 anos, não ter companheiro, ter alta escolaridade, ter maior nível econômico, usar serviços privados, ter autopercepção de saúde bucal boa/ótima, não ter autopercepção de necessidade de tratamento, ter recebido orientação sobre prevenção e ter manifestado opinião favorável ao profissional. O uso regular foi pouco freqüente, especialmente entre os menos favorecidos (15%). Restringindo a análise apenas para usuários do serviço público, observou-se maior utilização regular entre os mais escolarizados. Os serviços de saúde, em especial o público, devem trabalhar a fim de incrementar o uso regular e preventivo.

Racial and Ethnic Variation in the Provision of Dental Procedures

OBJECTIVES

Most of the available information on racial/ethnic disparities in oral health is based on differences in sociodemographic variables related to dental disease burden, dental visits, and access to care. However, very little is known regarding racial/ethnic variation in the provision of dental procedures. This study examined trends in the provision of dental procedures and sought to determine whether there are racial/ethnic differences in the provision of dental procedures.

METHODS

This is a retrospective observational study of patients treated at a dental training institution. Data for all patients 18 to 60 years of age in axiUm (electronic database) for 2001 to 2003 were analyzed. Data include demographic information, poverty status, insurance coverage, dental procedure, and race/ethnicity. Separate logistic regression models (by dental procedure category and year) were fitted while considering race/ethnicity, insurance coverage, poverty status, marital status, and age as possible covariates.

RESULTS

The total number of dental procedures completed by providers increased by 14,000 between 2001 and 2003. African-Americans were significantly less likely to have restorative procedures [odds ratio (OR): 0.60, 95 percent confidence interval (CI): 0.42 to 0.86], (OR: 0.52, 95 percent CI: 0.38 to 0.73), (OR: 0.46, 95 percent CI: 0.36 to 0.58) in 2001, 2002, and 2003, respectively, than the White population. Significant differences in the use of other dental procedures (prosthodontics--removable) and oral surgery procedures by race/ethnicity were observed.

CONCLUSIONS

Substantial racial/ethnic variation in the provision of dental procedures exists. This study presents findings beyond anecdotal information on racial/ethnic variation in the provision of dental procedures and requires further research to compile more detailed data.

A longitudinal study of medication exposure and xerostomia among older people

OBJECTIVE

To describe the incidence of xerostomia among a population of older people over a 6-year period, with particular attention to medications as risk factors.

BACKGROUND

Understanding the natural history of xerostomia requires longitudinal epidemiological research, but only one study has examined changes in xerostomia over time. While medication is a recognised risk factor for dry mouth, the role of particular medication categories continues to be controversial.

MATERIALS AND METHODS

Older South Australians (aged 60+) underwent an interview and dental examination at baseline, and these assessments were repeated 2, 5 and 11 years afterward. Medication data were collected at baseline, 5 and 11 years. Xerostomia data were collected at 5 and 11 years using the Xerostomia Inventory (XI) and a standard question.

RESULTS

Of the 1205 dentate participants assessed at baseline, 669 remained after 5 years, and 246 were assessed at 11 years. Medication prevalence increased over the observation period, such that 94.8% of the cohort were taking at least one medication by 11 years. The prevalence of xerostomia increased from 21.4% to 24.8% between 5 and 11 years (p > 0.05), and the mean XI score increased from 20.0 (SD, 6.7) to 21.5 (SD, 7.9; p < 0.001). Some 14.7% of participants were incident cases of xerostomia, while 11.4% were remitted cases; 10.1% were cases at both 5 and 11 years. After controlling for gender and 'baseline' xerostomia severity (represented by the XI score at 5 years), participants who commenced taking daily aspirin after 5 years had over four times the odds of becoming incident cases, while those who commenced taking a diuretic after 5 years had nearly six times the odds of doing so.

CONCLUSIONS

While the overall prevalence of xerostomia increased during the observation period, there was considerable instability, with one-quarter of the cohort changing their status. Medication exposure was strongly associated with the incidence of the condition, with recent exposure to diuretics or daily aspirin strongly predicting it.

A cohort study found racial differences in dental insurance, utilization, and the effect of care on quality of life

OBJECTIVE

To describe racial differences in receipt of dental services and dental insurance; and to determine the effectiveness of specific dental services in facilitating recovery in symptom-specific and race-specific subgroups.

STUDY DESIGN AND SETTING

Using a restricted cohort analytic method, Florida Dental Care Study prospective cohort data were used to quantify associations between dental service use and the quality of life measure, "recovery" from oral disadvantage due to functional limitation.

RESULTS

Non-Hispanic Whites (NHW) were more likely to have a dental visit [odds ratio (OR); 95% confidence interval: 3.5; 2.2-5.3], corrective treatment (OR=2.1; 1.3-3.3), caps (OR=28.8; 6.6-126.4), and dental insurance coverage for caps (OR=2.9; 1.4-5.9). After adjusting for other covariates: (1) among NHW with severe gum disease, those receiving extractions were more likely to recover (OR=7.8; 1.0-59.1), but those receiving caps were less likely to recover (OR=0.1; 0.01-0.6); (2) among Non-Hispanic Blacks (NHB) with a sensitive tooth, those receiving corrective treatment (OR=3.2; 1.2-8.8) or extractions (OR=3.8; 1.3-11.2) were more likely to recover; (3) among NHB with tooth disease, those receiving corrective treatment (OR=2.3; 1.0-5.0) and extractions (OR=2.8; 1.2-6.5) were more likely to recover.

CONCLUSION

There were racial differences in dental insurance, in the receipt of dental services and in the effectiveness of dental services in improving oral health-related quality of life.

Social determinants of tooth loss

OBJECTIVES

To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities.

DATA SOURCES/STUDY SETTING

The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whites 45 years old or older who had at least one tooth.

STUDY DESIGN

We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth-specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth.

DATA COLLECTION METHODS

In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months.

PRINCIPAL FINDINGS

African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account.

CONCLUSIONS

Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth-specific case-mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.

Incidence of dental radiographic procedures during a 48-month population-based study of dentate adults

OBJECTIVES

The purpose of this population-based study was to quantify the incidence of radiographic procedures and the intervals between radiographic exposures.

STUDY DESIGN

The Florida Dental Care Study was a prospective cohort study of a representative sample of dentate adults. In-person interviews and dental examinations were conducted at baseline, with subsequent interviews every 6 months during 48 months of follow-up. Dental record information was abstracted afterward.

RESULTS

Thirteen percent of all dental procedures, and 42% of all diagnostic procedures, were radiographic. Annual person-level incidence of receipt of any radiograph was 48%. Incidence of specific types of radiographic procedures ranged from 5% to 30%. Among the 45% of the sample population who had had more than 1 bitewing procedure, 70% of the intervals between bitewing exposures were 1 year or longer. Receiving more than 1 full-mouth series or panoramic radiographic in any 24-month period was very rare.

CONCLUSIONS

Annual incidence of radiographic procedures was substantially higher than the incidence reported in previous studies based on responses by dentists to hypothetical situations, but was stable during the 4 years of follow-up. On the basis only of intervals between exposures, and not of clinical status on the day of service, there was no substantial evidence of inappropriately frequent radiographic examinations.

Race/ethnic differences in health care use for orofacial pain among older adults

The purpose of this study was to describe race/ethnic differences in the use of formal health care services for painful oral symptoms by older adults. We also considered the sex of the respondent rather than assuming that males and females within a specific racial group would use health care services similarly. To our knowledge, these specific utilization patterns have never been reported before in the pain literature.Telephone interviews were conducted on a stratified random sample of 1,636 community dwelling older (65+) north Floridians. A total of 5,860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. Overall race/ethnic differences in patterns of health care use for orofacial pain were not found. However, when we stratified race/ethnicity by sex, Black females (37.6%) were the least likely to have visited a health care provider, followed by non-Hispanic White females (47.2%), non-Hispanic White males (49.3%), and Black males (62.7%). Point estimates of odds ratio, adjusting for financial differences, indicate that more non-Hispanic White males (OR=1.79) and Black males (OR=2.74) visited a health care provider than Black females. Our results also suggest that for older Black adults, financial constraints have a more significant impact on decisions about health care for orofacial pain than they do for non-Hispanic Whites. For non-Hispanic White respondents, characteristics of the pain symptoms were significant determinates of health care use for their painful oral symptoms. Pain at its worst was a positive predictor for four of the five analyses (jaw joint pain, painful oral sores, temperature sensitivity, and toothache pain). The duration variable (years with pain) was a negative predictor of health care use. This is consistent with the conclusion that individuals seek care early in the course of the symptom, i.e. an active care seeking phase, make emotional or physical adjustments, and then resign themselves to the symptoms.