Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged.

BACKGROUND: For accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable. METHODS: This study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)]. RESULTS: Approximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care. CONCLUSION: In the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.

Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study.

BACKGROUND: In Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health. METHODS: This study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)-bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables. RESULTS: Analysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20-39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as "fair to poor" more than those earning more. Adjusted estimates revealed that respondents aged 20-39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12-19. Additionally, those aged 40-59 were two times more likely to report poorer oral health status compared to those aged 12-19. CONCLUSION: Given the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.

Measuring the quality of dental care among privately insured children in the United States.

OBJECTIVE: To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns. DATA SOURCE: Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019. STUDY DESIGN: A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality. DATA COLLECTION/EXTRACTION METHODS: Continuously enrolled US dental insurance beneficiaries younger than 21 years of age. PRINCIPAL FINDINGS: Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score. CONCLUSION: Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.

Access to root canal treatment in a Nigerian sub-population: assessment of the effect of dental health insurance.

BACKGROUND: The final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT). AIM: To determine the extent to which individuals' financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT. METHODS: A hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associations between the subjects' variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval. RESULTS: Two hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p < 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest proportion (90%, p = 0.421) of insured that visited for RCT. CONCLUSION: Dental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.

Asthma, long-term asthma control medication and tooth wear in American adolescents and young adults.

OBJECTIVE: This study explored the associations of asthma and long-term asthma control medication with tooth wear among American adolescents and young adults. METHODS: Data from 2186 participants of the National Health and Nutrition Examination Survey (NHANES) were used. Asthma and prescribed long-term medication were collected through questionnaires. The number of surfaces with tooth wear was determined during clinical examinations. Associations were tested in Hurdle regression models adjusting for confounders. RESULTS: The prevalence of tooth wear was 58%, with an average of 6.1 (SD: 4.0) surfaces affected among those with the condition. The prevalence of asthma was 10.3%, with 2.9% of participants using long-term medication for asthma control. In the adjusted regression model, asthma was not associated with tooth wear. However, long-term control medication was associated with greater odds of having tooth wear (odds ratio: 3.33; 95%CI: 1.24-8.97), but it was not associated with the number of surfaces with tooth wear among those with the condition (rate ratio: 1.01; 95% CI: 0.58-1.75). CONCLUSION: This cross-sectional analysis of national data shows that taking long-term asthma medication was positively associated with having tooth wear.

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

OBJECTIVE: 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. DATA SOURCES: Medical Expenditure Panel Survey (2011-2016), Area Health Resources File, and Medicaid adult dental coverage policies. STUDY DESIGN: 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. PRINCIPAL FINDINGS: 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. CONCLUSION: 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.

Racial/Ethnic Disparities Among US Children and Adolescents in Use of Dental Care.

INTRODUCTION: Dental care among children has increased over the past decade, and racial/ethnic disparities have narrowed for some groups. We measured changes in racial/ethnic disparities in annual dental care for children and adolescents aged 2 to 17 years and conducted multivariate analysis to study factors associated with changes in disparities over time. METHODS: We used Medical Expenditure Panel Survey data to obtain crude prevalence estimates of dental care use and calculated absolute disparities and changes in disparities for 3 racial/ethnic groups of children and adolescents compared with non-Hispanic white children and adolescents relative to fixed points in time (2001 and 2016). We pooled all single years of data into 3 data cycles (2001-2005, 2006-2010, and 2011-2016) and used multivariate regression to assess the relationship between dental care use and race/ethnicity, controlling for the covariates of age, sex, parents' education, household income, insurance status, and data cycle (time). RESULTS: Use increased by 18% only in low-income children and adolescents. Low-income Hispanic (adjusted prevalence ratio [aPR] = 0.98; 95% CI, 0.94-1.02) and Asian (aPR = 0.92; 95% CI, 0.83-1.02) participants showed no difference in dental care use relative to non-Hispanic white participants, but non-Hispanic black participants had significantly lower use (aPR = 0.84; 95% CI, 0.81-0.88). Public and private insurance were associated with a doubling of use among low-income children. CONCLUSION: We saw a modest increase in dental care use and a narrowing of disparities for some low-income children and adolescents. Use among low-income Hispanic and Asian participants "caught up" with use among Hispanic white participants but remained well below that of children and adolescents in families with middle and high incomes. Disparities persisted for non-Hispanic black participants at all income levels.

Providing dental insurance can positively impact oral health outcomes in Ontario.

BACKGROUND: Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. METHODS: We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013-2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada's most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. RESULTS: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9-24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6-11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9-19.8 vs. ME lowest: 27.2; 95% CI: 25.0-29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: - 13.2 to - 9.9 vs. ME lowest: -27.2; 95% CI: - 29.5 to - 24.8). CONCLUSIONS: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

Changes in emergency department dental visits after Medicaid expansion.

OBJECTIVES: To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care. STUDY DESIGN: Retrospective, quasi-experimental study. DATA SOURCES/STUDY SETTING: We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences-in-differences regression to estimate changes in insurance for dental visits by nonelderly adults. PRINCIPAL FINDINGS: Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self-pay for ED dental visits. CONCLUSIONS: Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits.

Prevalence and Factors Associated with Visiting the Dentist Only for Emergency Care Among Indigenous People in Ontario.

Ontario has the largest Indigenous population in Canada. This study aims to examine the prevalence and factors associated with poor dental care use amongst the Indigenous in Ontario. Data from the 2014 cycle of the Canadian Community Health Survey was used. The main outcome was defined as visiting the dentist only for emergency care. Stepwise multivariable logistic regression was performed to assess the association between socio-demographic, socio-economic, and the health related factors and emergency dental care use. 28% of the participants reported visiting the dentist only for emergencies. First Nations people were at increased odds of having poor dental care (OR 2.01, CI 1.12-3.95). Additionally, being male, a smoker, having fair/poor health and lacking dental insurance puts the Indigenous Ontarians at increased odds of having the outcome. Improvements to the current social benefit programs could help better cater to the needs of this population.

Regional and gender differences in population-based oral health insurance data.

OBJECTIVE: Early dental monitoring contributes substantially to good oral health in children. However, little is known on whether children from different geographical regions and gender are equally reached with current preventive and curative oral health strategies. The aim of our study therefore was to explore regional and gender differences in a population-based oral health dataset of Austrian children up to the age of 14. MATERIALS AND METHODS: We extracted the first electronically available health insurance data of children aged up to 14 years on dental services within a 4-year observation period in Austria and performed a separate analysis in up to 6-year-old children. In addition, we used a smaller randomly selected sample dataset of 3000 children as the large numbers would result in significant, but very small effects. RESULTS: In a total of 130,895 children, of whom 77,173 children (59%) were up to the age of six, we detected an east-west gradient: The eastern regions of Austria showed an older age at first contact and a higher number of dental services. A child aged up to 6 years who needed more than four dental services had a likelihood of 40% to be from Vienna, Austria's capital city located in the east. The smaller random sample did not show significant gender differences. CONCLUSIONS: Even in regions with a high density of dentists, such as Vienna, we obviously did not reach young children in the same extent as in other regions. CLINICAL RELEVANCE: Stratified interventions could be developed to overcome regional inequalities.

A crossectional investigation of the relationship between complementary health insurance and frequency of dental visits in 15 to 64 years old of Tehran population, Iran, a secondary data analysis (urban HEART-2).

BACKGROUND: This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. METHODS: The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. RESULTS: The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. CONCLUSION: Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.

The Impact of the ACA Medicaid Expansions on Dental Visits by Dental Coverage Generosity and Dentist Supply.

BACKGROUND: Low-income adults in the United States have historically had limited access to dental coverage and poor dental health outcomes. OBJECTIVE: We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply. RESEARCH DESIGN: We used data from 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals <138% federal poverty level. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by the generosity of dental coverage and dentist supply. RESULTS: Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from preexpansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase, however, was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply. CONCLUSIONS: Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.

Children's Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007-2015).

We evaluated the effect of the National Health Insurance (NHI) policy including dental sealant on changes in the prevalence of sealant and caries, and examined how NHI affected sealant utilization and untreated caries in children from diverse income groups in South Korea. We used a multivariate logistic regression analysis to explore the effects of three stages of dental sealant policy (pre-policy: 2007-2009, first post-policy: 2010-2012, and second post-policy: 2013-2015) on the prevalence of dental sealant and untreated caries. Participant data (N = 8161, aged 6-14 years) were derived from the Korea National Health and Nutrition Examination Survey (2007-2015). We also conducted subgroup analysis to determine the effects of the NHI policy on dental sealant and untreated caries by income level. Implementation of dental insurance coverage was associated with higher likelihood of using dental sealant (odds ratio (OR) = 1.39 (95% confidence interval (CI): 1.18-1.63) for the first period and OR = 1.58 (95% CI: 1.33-1.87) for the second period) and lower odds of having untreated caries (OR = 0.79 (95% CI: 0.64-0.98) for the first period and OR = 0.65 (95% CI: 0.51-0.83) for the second period) after controlling for covariates. Results revealed that there was a greater prevalence of dental sealant and a lower prevalence of untreated caries in both middle- and low-income households compared to high-income households. The higher prevalence of dental sealant and lower untreated caries after the policy implementation. Moreover, we demonstrated children from low-or middle-income households were more associated with increasing dental sealant use and a declining prevalence of caries.

The High Coverage of Dental, Vision, and Hearing Benefits Among Medicare Advantage Enrollees.

While the traditional Medicare program does not cover dental, vision, and hearing services, Medicare Advantage (MA) plans have been given the flexibility to do so. However, it is not known how many MA enrollees are in plans that cover these services. The 2016 Medicare Current Beneficiary Survey linked to MA plan benefit data is used to examine enrollment levels in plans that cover dental, vision, and/or hearing services in MA. Medicaid beneficiaries are excluded from this analysis as coverage of supplemental benefits is largely determined by the state. The highest coverage of supplemental services is vision, followed by hearing and dental (71%, 56%, and 41%, respectively). Across all supplemental services, coverage for supplemental benefits is highest among low-income beneficiaries and those who have not completed high school. Hispanic Medicare beneficiaries had the highest enrollment in plans that offered a supplemental benefit, and white Medicare beneficiaries tended to have the lowest enrollment in these plans. Unlike in traditional Medicare, MA enrollees have access to health plans that offer supplemental benefits, including dental, vision, and/or hearing services. This analysis shows that enrollment in these plans is highest among low-income MA enrollees who may not have the means to purchase stand-alone insurance for these services in traditional Medicare. More analysis is warranted to examine the generosity of the coverage of these services in MA plans. However, for federal policy makers to consider offering supplemental coverage in traditional Medicare, the MA experience suggests this type of benefit would be valuable.

Dental Care Among Adults Aged 65 and Over, 2017.

Dental care is often an overlooked aspect of overall health care among older adults. Regular dental care is recommended for all older adults, even those with full dentures (1). Because Medicare does not cover routine dental care, older adults may have trouble accessing appropriate dental care (2). This report describes the prevalence, overall and by selected characteristics, of dental insurance, dental visits, and unmet need for dental care due to cost among adults aged 65 and over.

Regional Variation in Private Dental Coverage and Care Among Dentate Adults Aged 18-64 in the United States, 2014-2017.

Routine dental care can promote oral health (1,2), and those with private dental insurance are more likely to visit a dentist than those with other types of dental coverage or no coverage (3,4). Geographical variation in dental coverage and care among adults under age 65 exists (5,6), as does the availability of dental health professionals (7). This report examines regional variation in dental coverage among dentate adults (i.e., adults who have not lost all permanent teeth) aged 18-64 who had private health insurance in the past year, their utilization of dental care, and unmet dental needs due to cost in the past year.

Factors Associated with Preventive Dental Visits Before and During Pregnancy.

Objective: Poor prenatal oral health has implications for maternal, fetal, and infant health. Studies have shown an association between periodontal disease and adverse pregnancy outcomes, such as preterm delivery, low birth weight, and pre-eclampsia. The objective of this study was to identify the factors associated with preventive dental visits before and during pregnancy and examine the relationship of dental insurance with those visits among Virginia women. Methods: The Virginia Pregnancy Risk Assessment Monitoring System (2012-2014) cross-sectional data were used to explore the use of dental cleaning visit among women. The bivariate and multivariate analyses included sociodemographic variables, health risk factors, chronic conditions, oral health knowledge, and oral health promotion variables. All estimates were weighted; p < 0.05 was considered statistically significant. Results: A total of 1,344 weighted respondents represented ∼293,608 women in Virginia. Overall, 56% of women reported a before pregnancy dental cleaning visit, and 47% of women reported a during pregnancy dental cleaning visit. Nearly 60% of women were non-Hispanic white, 78% were between 20 and 34 years of age, and 67% reported having dental insurance. Dental insurance (odds ratio [OR] = 3.5; 95% confidence interval [95% CI] = 2.17-5.67) and oral health knowledge (OR = 2.8; 95% CI = 1.42-5.48) were associated with before pregnancy dental visit. During pregnancy dental visit was strongly associated with dental insurance (OR = 5.8; 95% CI = 2.80-11.97), before pregnancy dental visit (OR = 20.72, 95% CI = 11.14-38.54), and oral health promotion by health provider (OR = 12.37, 95% CI = 7.31-20.93). Conclusions: Overall, the use of a preventive dental visit before and during pregnancy was low among Virginia women. Improving the use of routine dental visits before pregnancy, increasing access to dental insurance, and engaging health care providers to promote oral health can impact the use of dental care during pregnancy.

Predictors of dental care utilization in north-central Appalachia in the USA.

OBJECTIVES: Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. METHODS: This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. RESULTS: On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). CONCLUSIONS: Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.

Did malpractice claims for failed dental implants decrease after introduction of CBCT in Finland?

OBJECTIVES: To examine the role of cone beam computed tomography (CBCT) in preventing failures in implant treatment. We hypothesize that the number of malpractice claims related to dental implant treatment would decrease after the first CBCT device came available in 2002 in Finland. MATERIAL AND METHODS: Data concerning malpractice claims related to dental implant treatment during the years 1997-2011 were collected from the Finnish Patient Insurance Centre (N = 330 subjects). We selected the cases that might have benefitted from the use of CBCT examination. These cases (n = 131) led to financial compensation due to permanent inferior alveolar nerve injury, improper implant position, or insufficient amount of bone for the implant. The annual total number of inserted dental implants, CBCT devices, and CBCT examinations in Finland were drawn from the national registers and used to estimate the impact of CBCT in preventing treatment failures. RESULTS: The most common reason for all failures (n = 268 implants) was an improper implant position (46.3%). The most common area of malpractices was upper front teeth (34%). We have noticed a fall in the rate of compensable malpractice cases concerning implant failure, simultaneously with CBCT technology emerging on the market. CONCLUSIONS: There may be an association between the increasing availability of CBCT equipment and the reducing frequency of compensable malpractice claims. CLINICAL RELEVANCE: It is possible that the use of CBCT may result in fewer compensable malpractice claims.