Abstract
Background About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated differences in dental care utilization between adults with and without diabetes.
Objectives To compare dental care utilization between adults with and without diabetes using a novel application of hurdle models, a statistical approach that decomposes utilization into components representing the decision to use services, the specific type of services used, and the amount of services used.
Methods/Research Design We conducted a retrospective cohort study using data from Washington Dental Service and linked records from Group Health Cooperative on enrollees continuously and dually insured between January 1, 2002 and December 31, 2006. Five years of follow-up dental utilization was compared between adults with and without diabetes. Propensity score matching was used to adjust for differences in baseline covariates between the two groups.
Results Post-matching multivariable results show that adults with diabetes had lower odds of visiting a dentist (OR=0.74, P<0.001). Among those with a dental visit, patients with diabetes had lower odds of receiving prophylaxes (OR=0.77, P<0.001), fillings (OR=0.80, P<0.001) and crowns (OR=0.84, P<0.005) and higher odds of receiving periodontal maintenance (OR=1.24, P<0.001), non surgical periodontal procedures (OR=1.30, P<0.001), extractions (OR=1.38, P<0.001) and removable prosthetics (OR=1.36, P<0.001).
Conclusions Our results underscore the need to instill appropriate changes in oral care seeking behavior that will help adults with diabetes receive early intervention, possibly reducing subsequent severe oral disease and costs. We recommend that organizations focused on oral health and diabetes care work jointly to initiate programs that educate patients with diabetes about preventive care and promote periodic dental visits. We also recommend that dental carriers not only increase dental coverage for adults with diabetes but also develop incentive products to promote preventive care seeking behavior.
