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Okunev I, Tranby EP, Jacob M, Diep VK, Kelly A, Heaton LJ, Frantsve-Hawley J. The impact of underutilization of preventive dental care by adult Medicaid participants. J Public Health Dent 2022; 82:88-98. [PMID: 35014702 PMCID: PMC9303757 DOI: 10.1111/jphd.12494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
Objective To ascertain the financial impact associated with the underutilization of preventive dental care for adults enrolled in Medicaid. Methods We used adult claims data for patients aged 21–64 in the IBM Watson Marketscan Medicaid database. Enrollees were included if they had at least one dental claim in 2019 and were continuously enrolled between 2014 and 2019. We then evaluated the costs of their dental care in 2019, based on the number of years of preventive dental care they received between 2014 and 2018. We also assessed Emergency Department (ED) utilization for dental conditions, oral surgeries, and dental‐related opioid prescriptions. Results The average Medicaid enrollee with five continuous years of preventive care prior to 2019 experienced 43% lower costs than an individual who received no preventive dental care at all. Most of the savings were a result of fewer oral surgeries. A Medicaid enrollee with no preventive dental visits was eight times more likely to have an ED visit for a nontraumatic dental condition (NTDC), seven times more likely to have oral surgery and six times more likely to receive a dental‐related opioid prescription compared to those who had a dental prevention visit every year in the 5‐year lookback period. Conclusions Regular preventive dental care in the lookback period was associated with significant savings in overall dental care costs when compared to dental care costs for those individuals who received no or few preventive visits. Prior preventive dental care was also associated with lower rates of ED‐NTDC utilization, oral surgery, and dental‐related opioid prescriptions.
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Affiliation(s)
- Ilya Okunev
- Health Data Analytics Institute, Dedham, Massachusetts, USA
| | - Eric P Tranby
- Analysis and Evaluation, CareQuest Institute for Oral Health, Boston, Massachusetts, USA
| | - Matt Jacob
- Jacob Strategies LLC, Arlington, Virginia, USA
| | - Vuong K Diep
- Life Sciences, UnitedHealth Group, Waltham, Massachusetts, USA
| | | | - Lisa J Heaton
- Analysis and Evaluation, CareQuest Institute for Oral Health, Boston, Massachusetts, USA
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Goldfarb MB, Maupomé G, Hirsh AT, Carvalho JC, Eckert GJ, Hara AT. Dentists clinical decision-making for erosive tooth wear: An online pilot study. J Dent 2020; 100:103424. [DOI: 10.1016/j.jdent.2020.103424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 10/24/2022] Open
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Andrade FBD, Antunes JLF, Andrade FCD, Lima-Costa MFF, Macinko J. Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries. J Dent Res 2020; 99:1341-1347. [PMID: 32623932 DOI: 10.1177/0022034520935854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.
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Affiliation(s)
- F Bof de Andrade
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J L F Antunes
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - F C D Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - M F F Lima-Costa
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Testa A, Fahmy C. Oral health status and oral health care use among formerly incarcerated people. J Am Dent Assoc 2020; 151:164-173. [PMID: 31955811 DOI: 10.1016/j.adaj.2019.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Incarceration carries adverse consequences for health, yet there is limited research on the association between incarceration and oral health outcomes. The authors examined the relationship between former incarceration and 2 self-reported oral health outcomes-periodontal disease and oral health care use-and assessed the degree to which postrelease factors mediate the relationship between former incarceration and oral health outcomes. METHODS The authors analyzed nationally representative observational data from the National Longitudinal Study of Adolescent to Adult Health by using multivariate logistic regression. Karlson-Holm-Breen mediation analysis was used to assess how much former incarceration and oral health outcomes are confounded by material hardship, health insurance coverage, and poor health behaviors. RESULTS Incarceration history is associated with periodontal disease (odds ratio [OR], 1.454; 95% confidence interval [CI], 1.042 to 2.029) and oral health care use (OR, 1.433; 95% CI, 1.248 to 1.646) after control variables are taken into account. However, the confounding variables fully mediate the association between incarceration and periodontal disease (OR, 1.143; 95% CI, 0.815 to 1.605) and oral health care use (OR, 1.133; 95% CI, 0.980 to 1.309). CONCLUSIONS Formerly incarcerated people in the United States have worse oral health outcomes than their never-incarcerated counterparts, and much of this relationship can be explained by socioeconomic status and health behaviors. PRACTICAL IMPLICATIONS Formerly incarcerated people have scarce resources and lack knowledge about oral health care. Health care professionals should encourage formerly incarcerated people to focus on oral health care. Because modifiable risk behaviors confound much of this relationship, targeted interventions may provide benefits for improving oral health care among this vulnerable population.
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Goldfarb MB, Hara AT, Hirsh AT, Carvalho JC, Maupomé G. Are dental patients able to perceive erosive tooth wear on anterior teeth?: An internet-based survey assessing awareness and related action. J Am Dent Assoc 2019; 151:10-15. [PMID: 31784028 DOI: 10.1016/j.adaj.2019.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Erosive tooth wear (ETW) is irreversible loss of dental hard tissue. The authors examined patients' ability to recognize ETW relative to sound teeth and teeth with caries. METHODS Using Amazon's crowdsourcing service, the authors recruited participants (N = 623) to view standardized images of buccal surfaces of teeth (sound, ETW, or caries). Participants reported whether a dental condition existed (yes or no), likelihood to seek care, and esthetic attractiveness for teeth with no, initial, moderate, or severe signs of ETW or caries. RESULTS Dental patients showed poor recognition of cases of ETW, especially compared with sound and caries-affected teeth at each level of severity. Patients were less likely to schedule a dental appointment for care or treatment of teeth with ETW than for teeth with caries at each level of severity. Patients also found ETW more esthetically attractive than caries at each level of severity and found initial ETW more attractive than sound teeth. CONCLUSIONS Dental patients struggle to recognize ETW, in general and compared with caries, at each level of severity and particularly for early stages of ETW. These recognition difficulties likely arise, in part, from tooth esthetic attractiveness standards (smooth and shiny teeth look more esthetic), possibly leading to lack of appropriate care-seeking behavior. PRACTICAL IMPLICATIONS This internet-based tool may be used to assess dental patients' awareness and ability to recognize cases of ETW. Improved patient awareness might lead to seeking professional care to prevent or delay ETW progression.
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Yoon H, Jang Y, Choi K, Kim H. Preventive Dental Care Utilization in Asian Americans in Austin, Texas: Does Neighborhood Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102261. [PMID: 30332736 PMCID: PMC6210422 DOI: 10.3390/ijerph15102261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/05/2018] [Accepted: 10/13/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Hyunwoo Yoon
- School of Social Work, The Texas State University, San Marcos, TX 78666, USA.
| | - Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90007, USA.
| | - Kwangyul Choi
- Haskayne School of Business, Faculty of Environmental Design, University of Calgary, Calgary, AB T2N 1N4, Canada.
| | - Hyun Kim
- Department of Geography, University of Tennessee, Knoxville, TN 37996, USA.
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Herkrath FJ, Vettore MV, Werneck GL. Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis. PLoS One 2018; 13:e0192771. [PMID: 29420660 PMCID: PMC5805334 DOI: 10.1371/journal.pone.0192771] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.
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Affiliation(s)
- Fernando José Herkrath
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- * E-mail:
| | - Mario Vianna Vettore
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Kino S, Bernabé E, Sabbah W. The role of healthcare system in dental check-ups in 27 European countries: multilevel analysis. J Public Health Dent 2017; 77:244-251. [DOI: 10.1111/jphd.12204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Shiho Kino
- Division of Population and Patient Health; King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals; London UK
| | - Eduardo Bernabé
- Division of Population and Patient Health; King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals; London UK
| | - Wael Sabbah
- Division of Population and Patient Health; King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals; London UK
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