Patient-level and practice-level characteristics associated with receipt of preventive dental services: 48-month incidence.
OBJECTIVE
This study aims to: (a) quantify the incidence of preventive dental services [in-office fluoride application and dental cleaning (prophylaxis)]; (b) determine if these services are effectively targeted to patients with the highest need; and (c) quantify the role of practice characteristics and patient-level factors in service receipt.


METHODS
A population-based prospective cohort study was conducted with 873 adults who had at least one tooth at baseline, 743 of whom provided 48-month data. In-person interviews and clinical examinations were conducted biennially for 48 months, with 6-monthly telephone interviews in between. Dental records were abstracted afterward, and practices that served participants completed questionnaires. Analysis was limited to persons with at least one dental visit of any type during follow-up (87 percent of the sample).


RESULTS
Only 9 percent of the persons received at least one fluoride application; 75 percent received a dental cleaning. Persons with high need were actually less likely to have received preventive services. In multivariable regression analyses, characteristics of the practice in which the subject received care were very strongly related to fluoride receipt, independent of patient-specific characteristics.


CONCLUSIONS
One preventive procedure was common; the other was uncommon. However, practices did not effectively target high-risk patients for either procedure. Instead, both services were typically received by persons with the least need for them. These findings are consistent with the conclusion that practitioners greatly influenced the delivery of fluoride services, with substantial contributions also made by patient-level predisposing and enabling factors for both preventive services.
Gilbert
Gregg H
GH
Department of Diagnostic Sciences, UAB School of Dentistry, SDB Room 109, 1530 3rd Avenue, South Birmingham, AL 35294-0007, USA. ghg@uab.edu
Bader
James D
JD
Litaker
Mark S
MS
Shelton
Brent J
BJ
Duncan
R Paul
RP
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D019230:Dental Audit; D003729:Dental Care / Q000706:statistics & numerical data*; D003777:Dental Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D005457:Fluoridation / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019239:Practice Patterns, Dentists' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014600:Utilization Review