Effect of dental practice characteristics on racial disparities in patient-specific tooth loss.
OBJECTIVE
The objective of this study was to test the hypothesis that dental practice characteristics are associated with tooth loss incidence with both tooth-specific and patient-specific characteristics already taken into account.


METHODS
A population-based prospective cohort study was conducted. In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months. Practices that coincidentally served participants in the study completed practice characteristics questionnaires. To increase inferential power when testing practice-level effects, detailed tooth-specific and patient-specific data were simultaneously taken into account in tests for association between practice-level effects and tooth loss.


METHODS
Data were from the Florida Dental Care Study. The key health outcome was tooth loss, a leading measure of a population's oral health.


METHODS
Eight hundred seventy-three African-Americans and non-Hispanic whites who had at least 1 tooth.


RESULTS
Certain practice characteristics were associated with tooth loss, including the racial mix of the practice's patient population; persons who attended practices with higher percentages of African-Americans were more likely to receive a dental extraction regardless of the individual patient's race.


CONCLUSIONS
This is the first longitudinal report of increased risk for tooth loss resulting from practice-level effects. Although a patient-level racial disparity remained evident, and even with detailed tooth-specific and patient-level characteristics taken into account, racial differences in characteristics of practices attended independently contributed to the patient-level racial disparity in health.
Gilbert
Gregg H
GH
Department of Diagnostic Sciences, School of Dentistry, UAB School of Dentistry, Birmingham, Alabama 35294-0007, USA. ghg@uab.edu
Shewchuk
Richard M
RM
Litaker
Mark S
MS
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D003757:Dental Implantation / Q000706:statistics & numerical data; D005431:Florida; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D019239:Practice Patterns, Dentists' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014081:Tooth Extraction / Q000706:statistics & numerical data; D016388:Tooth Loss / Q000208:ethnology*; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*