Unmet Dental Needs in Rural Primary Care: A Clinic-, Community-, and Practice-based Research Network Collaborative

Melinda M. Davis; Thomas J. Hilton; Sean Benson; Jon Schott; Alan Howard; Paul McGinnis; Lyle Fagnan

doi:10.3122/jabfm.2010.04.090080

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Table 1.

Demographic Characteristics of Eligible Patients and Patients Who Received the Oral Health Screening, Dental Access Survey, or both Screening and Survey during the 6-Week Study Period*

Characteristic	Eligible Patients^† (n [%])	Patients Completing Survey^‡ (n [%])	Patients Who Received Oral Screening^§ (n [%])	Patients Who Completed the Survey and Who Received an Oral Screening^‖ (n [%])
Total patients	1655 (100)	1108 (66.9)	674 (40.7)	591 (35.7)
Sex
Male	597 (36.1)	394 (35.6)	227 (33.7)	202 (34.2)
Female	1058 (63.9)	714 (64.4)	447 (66.3)	389 (65.8)
Age (years)
1–4	117 (7.1)	59 (5.3)	42 (6.2)	33 (5.6)
5–14	142 (8.6)	90 (8.1)	56 (8.3)	52 (8.8)
15–44	503 (30.4)	333 (30.1)	213 (31.6)	187 (31.6)
45–64	485 (29.3)	328 (29.6)	189 (28.0)	166 (28.1)
≥65	408 (24.7)	298 (26.9)	174 (25.8)	153 (25.9)

* Because of rounding, some percentage grouping totals do not equal 100%.
† Unique patients older than 12 months of age out of the 2316 total patient visits during the 6-week study period.
‡ χ² goodness-of-fit P = .730 for sex; P = .093 for age.
§ χ² goodness-of-fit P = .209 for sex; P = .741 for age.
‖ χ² goodness-of-fit P = .356 for sex; P = .642 for age.

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Table 2.

Outcomes of Oral Health Clinical Screening by Age Category (n = 674)

Outcomes (ICD-9-CM Diagnosis Codes)	All Patients (n [%])	Age (Years)
Outcomes (ICD-9-CM Diagnosis Codes)	All Patients (n [%])	1–4 (n [%])	5–14 (n [%])	15–44 (n [%])	45–64 (n [%])	≥65 (n [%])	P
Patients who received screening^*	674 (100.0)	42 (6.2)	56 (8.3)	213 (31.6)	189 (28.0)	174 (25.8)
No condition(s) detected (V70.7)	364 (54.0)	36 (9.9)	45 (12.4)	153 (42.0)	90 (24.7)	40 (11.0)	<.001
Oral health condition(s) detected	310 (46.0)	6 (1.9)	11 (3.6)	60 (19.4)	99 (31.9)	134 (43.2)
Distribution of detected oral health condition(s)^†
Partial edentulism (525.50)	165 (24.5)	1 (2.4)	1 (1.8)	26 (12.2)	68 (36.0)	69 (39.7)	<.001
Caries (521.00)	87 (12.9)	3 (7.1)	9 (16.1)	40 (18.8)	23 (12.2)	12 (6.9)	.007
Complete edentulism (525.40)	67 (9.9)	0 (0.0)	0 (0.0)	2 (0.9)	13 (6.9)	52 (29.9)	<.001
Broken/cracked teeth (521.81)	60 (8.9)	0 (0.0)	1 (1.8)	20 (9.4)	22 (11.6)	17 (9.8)	.048
Unspecified disorder (525.9)	10 (1.5)	2 (4.8)	1 (1.8)	2 (0.9)	1 (0.5)	4 (2.3)	.238
Abscess (522.5)	5 (0.7)	1 (2.4)	0 (0.0)	1 (0.5)	1 (0.5)	2 (1.1)	.614

* Percentages in the first 3 rows are based on the number of patients in the age category divided by the number in the “All Patients” column.
† For the subcategories of detected oral health condition(s), percentages are based on the number of patients who received the screening within each age category (ie, caries in the 1–4 years old category: 3/42 = 7.1%). Note that some patients had more than one condition detected.
ICD-9-CM, International Statistical Classification of Diseases and Related Health Problems 9—Clinical Modification.

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Table 3.

Results from the Patient Survey (n = 1108)

Variables	n (%)
Insurance
Health (yes)	1006 (91.2)
Dental (yes)	571 (51.9)
Health and dental (yes)	567 (56.5)
Source of regular dental care (yes)	717 (66.0)
Tried to see dentist during the past year	654 (59.5)
Had a dental visit during the past year	596 (53.8)
Self-rated oral health
Poor	128 (11.7)
Average	345 (31.5)
Good	428 (39.1)
Excellent	194 (17.7)
Self-rated overall health
Poor	80 (7.4)
Average	323 (29.7)
Good	530 (48.7)
Excellent	155 (14.2)
Unmet dental need (yes)	304 (28.0)
Stated unmet dental needs by condition^*
Cavities/fillings/crowns	124 (11.2)
Dentures	71 (6.4)
Exam/cleaning	54 (4.9)
Extractions	44 (4.0)
Broken/cracked teeth	28 (2.5)
Lack of money/needs insurance	37 (3.3)
Other coded conditions^†	52 (4.7)
Other miscellaneous^‡	34 (3.1)

* Total stated unmet dental need categories do not add to 304 unique patients because survey respondents could self-report multiple unmet needs.
† Other coded conditions included periodontics (n = 15, 1.4%); endodontics (n = 11, 1.0%); orthodontics (n = 11, 1.0%); bridges (n = 11, 1.0%); and general statements such as “a lot” (n = 5, 0.5%). One patient reported multiple other coded unmet needs, thus individual values do not equal the table total (n = 52, 4.7%).
‡ Other miscellaneous included dental needs stated by patients that were not captured in the 11 coded categories. Most patients in this category also specified one of the coded unmet needs.

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Table 4.

Association of Insurance Status with Perceived Dental Needs and Health Outcomes (n = 1097)*

Dental/Health Outcome	Dental Insurance^† Relative to No Insurance^§		Health Insurance Only^‡ Relative to No Insurance^§
Dental/Health Outcome	OR (95% CI)	P	OR (95% CI)	P
Had source of regular dental care	6.4 (4.0–10.3)^‖	<.001	1.9 (1.2–3.0)	.008
Tried to see dentist during the past year	3.8 (2.4–6.0)^‖	<.001	1.9 (1.2–3.0)	.006
Had dental visit during the past year	2.9 (1.0–8.2)	.054	2.9 (1.0–0.9)	.061
Oral health rated good/excellent	2.8 (1.8–4.5)^‖	<.001	1.7 (1.1–2.7)	.024
Overall health rated good/excellent	1.9 (1.2–3.0)^‖	<.001	1.1 (0.7–1.7)	.82
No stated unmet dental need(s)	3.1 (2.0–4.9)^‖	<.001	2.0 (1.3–3.1)	.004

* Odds ratio (OR) estimates were limited to patients with information about both dental and health insurance status.
† 99.5% of patients (n = 567 of 570) with dental insurance also carried health insurance.
‡ 43.3% of patients (n = 433 of 1000) with health insurance did not carry dental insurance.
§ 8.5% of patients (n = 94) carried no insurance.
‖ Differences between dental insurance and health insurance significant at P ≤ .002.