Association between smoking habits and dental care utilization and cost using administrative claims database and specific medical check-up data

BACKGROUND

This study aims to evaluate the association between smoking habits and dental care utilization and cost in individuals registered with the Japan Health Insurance Association, Osaka branch.

METHODS

We used the administrative claims database and specific medical check-up data and included 226,359 participants, who visited dental institutions, underwent dental examinations, and underwent specific medical checkups, with smoking data from April 2016 to March 2017. We calculated propensity scores with age, gender, exercise, eating habits, alcohol intake, and sleep. We also compared dental care utilization with the total cost of each procedure.

RESULTS

According to propensity score matching, 62,692 participants were selected for each group. Compared to non-smokers, smokers were younger, and a higher proportion were men. Smokers tended to skip breakfast, have dinner just before bed, and drink alcohol. After adjusting for potential confounding factors with propensity score matching, the mean annual dental cost among smokers was significantly higher than non-smokers. The prevalence of pulpitis, missing teeth, and apical periodontitis were higher among smokers than non-smokers, while inlay detachment, caries, and dentine hypersensitivity were higher among non-smokers.

CONCLUSION

This study suggests that smokers have higher dental cost consisted of progressive dental caries, missing teeth, and uncontrolled acute inflammation that necessitated the use of medications. It is suggested that smokers tend to visit the dentist after their symptoms become severe.

Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation

Background

Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis.

Methods

We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions.

Results

Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses.

Conclusions

Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01932-2.

Dental Care Utilization among Veterans by Smoking Status

BACKGROUND

Given the critical importance of dental care utilization among veterans and the overall health consequences of tobacco use in all populations, the purpose of this research is to examine smoking as a risk factor for poor dental care utilization among United States Veterans.

METHODS

A secondary data analysis of cross-sectional data from the National Survey of Veterans was conducted. The primary outcome was dental care utilization (Yes, No). Frequency, chi-square analyses, and multivariate logistic regression statistical tests were performed while adjusting for confounding factors.

RESULTS

There were 6,308 veterans in the study. Veterans who were current smokers were less likely to have dental care utilization within the previous six months than former smokers or never smokers. In unadjusted logistic regression analysis, current smokers had an odds ratio of 2.83 [95% CI: 2.36, 3.40] as compared with never smokers. The adjusted odds ratio for current smoking on dental care utilization was 1.71 [95% CI: 1.40, 2.09] as compared with never smoking.

CONCLUSIONS

Since veterans who smoked are less likely to have dental care utilization within the previous six months, they are at higher risk for later diagnosis of dental problems. Veterans who smoke should be specifically targeted with interventions to ensure frequent dental visits, so future problems may be averted or managed early in their development.

Relationships between occupational and behavioral parameters and oral health status

The aim of the present study was to assess the influence of various workplace parameters and oral health behaviors on tooth decay, periodontal disease, and the number of teeth present in industrial workers. The study participants were 1,078 workers (808 males, 270 females, mean age 42.8 ± 11.4 yr) employed at 11 different workplaces. Oral examinations and a self-administered questionnaire were conducted for participants. A logistic regression analysis was conducted to identify factors related to their oral health status. Factors significantly associated with decayed teeth were smoking (OR=2.02), not having received tooth brushing instruction (OR=1.73), not having annual dental examinations (OR=1.64) and not brushing before sleeping (OR=0.55). The factors significantly associated with severe periodontal disease were employment with a company with fewer than 50 employees (OR=15.56) and not brushing teeth before bedtime (OR=2.41). The factors significantly associated with having 23 teeth or fewer were subjects in the education and learning support industry compared with manufacturing industry (OR=5.83) and transport industry (OR=12.01). The results of the present study showed that various occupational parameters and health behaviors are associated with oral health status including tooth decay, periodontal disease, and tooth loss.

Cost analysis of periodontitis management in public sector specialist dental clinics

BACKGROUND

The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components.

METHODS

Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4).

RESULTS

A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P < 0.001). Providers generally spent most on consumables while patients spent most on transportation.

CONCLUSIONS

Cost of providing dental treatment for periodontitis patients at public sector specialist settings were substantial and comparable with some non-communicable diseases. These findings provide basis for identifying potential cost-reducing strategies, estimating economic burden of periodontitis management and performing economic evaluation of the specialist periodontal programme.

The role of tobacco use on dental care and oral disease severity within community dental clinics in Japan

Background

To examine facilitators of dental smoking intervention practices in Japan, where smokeless tobacco is rarely used, we evaluated the characteristics of dental care for smokers.

Methods

Community dentists volunteered to record the treated disease or encounter with patients that was principally responsible for their dental care on the survey day. Patients were classified into groups receiving gingival/periodontal treatment (GPT), caries/endodontic treatment (CET), prosthetic treatment (PRT), periodical check-up/orthodontic treatment (POT), or other encounters/treatments. Potential effect of dentist clustering was adjusted by incorporating the complex survey design into the analysis.

Results

Data of 2835 current smokers (CS) and 6850 non-smokers (NS) from 753 clinics were analysed. Distribution of treatments significantly differed between CS and NS (P = 0.001). In ad hoc multiple comparisons for each treatment, CS were significantly higher than NS for CET (47.1% vs. 43.6%, P = 0.002), and lower for POT (1.6% vs. 2.7%, P = 0.001), whereas GPT and PRT proportions were equivalent by smoking. When stage of disease progression was compared in the GPT subpopulation, CS were more likely received treatment for advanced stage disease than NS in the age groups of 40–59 years (24.9% vs. 15.3%, P = 0.001) and more than 60 years (40.8% vs. 22.1%, P < 0.001). However, the difference was less apparent in the entire population (9.7% vs. 6.0%), and CS were not predominant among patients receiving GPT for advanced stage disease (37.6%).

Conclusions

The association of smoking with type of dental care of CET and GPT severity would warrant the need for dental professionals to engage their patients smoking within clinical practice. The detrimental effects of smoking in dental care for smokers, as evidenced by the distribution of treatment and encounter and stage of treated disease, may not be clearly realized by dental professionals, unless the smoking status of all patients is identified.

Estimation of the costs of smoking-related oral disease: a representative South Korean study

OBJECTIVES

The objectives of this study were to estimate the socioeconomic and psychological costs associated with smoking-related oral disease (SROD) with the aim of generating objective data that could be used in smoking cessation counselling by dental care providers and could also serve as data with which to set standards and criteria for use in dental health insurance.

METHODS

Patients were sourced from the 11 dental hospitals associated with dental schools in South Korea. A total of 1,288 of 10,080 patients with SROD were selected to participate in the study for a period of 2 years from January 2009 to March 2011. Data collected were analysed using spss Version 17.0.

RESULTS

Among the SRODs, the most common was periodontal disease (40.7%). Periodontal disease accounted for the highest social and economic costs. Mouth cancer accounted for the highest psychological cost.

CONCLUSIONS

In order to reduce associated socioeconomic and psychological costs, dental care providers and government should provide more proactive and more efficient smoking cessation programmes.

Relationship between receiving a workplace oral health examination including oral health instruction and oral health status in the Japanese adult population

OBJECTIVES

Dental caries and periodontal disease are highly prevalent in the Japanese adult population. Oral examination is an effective method to find various oral health problems in their early stages. However, workplace oral examination is not common in Japan. The purpose of this study was to examine the relationship between receiving workplace oral health examination, including oral health instruction, and oral health status in the Japanese adult population.

METHODS

This study was performed using data from 4,484 Japanese employees aged 35-74 yr. The proportion of teeth with a probing depth (PD) ≥4 mm and the number of decayed teeth were used for periodontal disease and dental caries parameters. The subjects were asked by questionnaire about past experiences with workplace oral health examination.

RESULTS

The subjects who received a workplace oral health examination every year had better periodontal health status than those receiving an examination for the first time. The odds ratio for having ≥10% of teeth with PD ≥4 mm in the subjects who received workplace oral health examination every year was 0.63 (p<0.05) after adjustment for age, sex, smoking habits, tooth-brushing habits, routine visits to dental clinics, number of missing teeth, and oral hygiene status, in a multivariate, multinomial logistic regression analysis. On the other hand, no significant relationship was found between workplace oral health examination and number of decayed teeth.

CONCLUSIONS

These results suggest that workplace oral health examination accompanied by oral health instruction may be effective for maintenance of periodontal health.

Periodontal disease and incident diabetes: a seven-year study

Diabetes is associated with a high prevalence of periodontal disease, but little is known about the effects of periodontal disease on incident diabetes. In total, 5848 non-diabetic individuals aged 30-59 yrs who completed a health examination were analyzed in this study. They were divided into three categories: no pathological pockets, moderate periodontitis, or severe periodontitis. Incident diabetes was defined as newly diagnosed cases with fasting plasma glucose > 125 mg/dL. Cox proportional hazards models estimated the effect of periodontitis on incident diabetes during a seven-year follow-up period. Moderate and severe periodontitis was significantly associated with an increased risk of diabetes in unadjusted analyses, but the magnitude of the association decreased after full adjustment [hazard ratio (HR) = 1.00, 95% confidence interval (95% CI) = 0.77-1.30 and HR = 1.28, 95% CI = 0.89-1.86, respectively]. Our findings do not indicate an apparent association between periodontitis and incident diabetes, although there was a tendency for increased risk.