Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models

BMC Oral Health. 2012 Jul 9;12:20. doi: 10.1186/1472-6831-12-20.


Background: About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes.

Methods: Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002-2006. Dental and medical records from WDS and GH were linked for enrollees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups.

Results: We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxis (OR = 0.77), fillings (OR = 0.80) and crowns (OR = 0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR = 1.24), non-surgical periodontal procedures (OR = 1.30), extractions (OR = 1.38) and removable prosthetics (OR = 1.36) (p < 0.001 for all).

Conclusions: Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Body Mass Index
  • Cohort Studies
  • Confounding Factors, Epidemiologic
  • Crowns / statistics & numerical data
  • Dental Care / statistics & numerical data*
  • Dental Prophylaxis / statistics & numerical data
  • Dental Prosthesis / statistics & numerical data
  • Dental Restoration, Permanent / statistics & numerical data
  • Diabetes Mellitus / epidemiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medicare / statistics & numerical data
  • Middle Aged
  • Odds Ratio
  • Periodontal Debridement / statistics & numerical data
  • Periodontal Diseases / epidemiology
  • Smoking
  • Tooth Extraction / statistics & numerical data
  • United States / epidemiology
  • Washington / epidemiology