title: Chronic kidney disease and use of dental services in a United States public healthcare system: a retrospective cohort study.
abstract: BACKGROUND
  As several studies have shown an association between periodontal disease and chronic kidney disease (CKD), regular dental care may be an important strategy for reducing the burden of CKD. Access to dental care may be limited in the US public health system.
  
  
  METHODS
  In this retrospective cohort study of 6,498 adult patients with (n = 2,235) and without (n = 4,263) CKD and at least 12 months of follow-up within the San Francisco Department of Public Health Community Health Network clinical databases, we examined the likelihood of having a dental visit within the observation period (2005-2010) using Cox proportional hazards models. To determine whether dental visits reflected a uniform approach to preventive service use in this setting, we similarly examined the likelihood of having an eye visit among those with diabetes, for whom regular retinopathy screening is recommended. We defined CKD status by average estimated glomerular filtration rate based on two or more creatinine measurements ≥ 3 months apart (no CKD, ≥ 60 ml/min/1.73 m2; CKD, < 60 ml/min/1.73 m2).
  
  
  RESULTS
  Only 11.0% and 17.4% of patients with and without CKD, respectively, had at least one dental visit. Those with CKD had a 25% lower likelihood of having a dental visit [HR = 0.75, 95% CI (0.64-0.88)] than those without CKD after adjustment for confounders. Among the subgroup of patients with diabetes, 11.8% vs. 17.2% of those with and without CKD had a dental visit, while 58.8% vs. 57.8% had an eye visit.
  
  
  CONCLUSIONS
  Dental visits, but not eye visits, in a US public healthcare setting are extremely low, particularly among patients with CKD. Given the emerging association between oral health and CKD, addressing factors that impede dental access may be important for reducing the disparate burden of CKD in this population.
authors.affiliation: San Francisco General Hospital, Division of Nephrology, University of California, San Francisco, USA. grubbsv@medsfgh.ucsf.edu
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Tuot
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003729:Dental Care / Q000706:statistics & numerical data*; D003930:Diabetic Retinopathy / Q000175:diagnosis; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012495:San Francisco; D014787:Vision Tests / Q000706:statistics & numerical data*; D055815:Young Adult