title: Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models.
abstract: 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.
authors: Washington Dental Service, 9706 Fourth Avenue NE, Seattle, WA 98115, USA. monica.chaudhari@gmail.com
authors: Monica
authors: M
authors: Chaudhari
authors: Rebecca
authors: R
authors: Hubbard
authors: Robert J
authors: RJ
authors: Reid
authors: Ronald
authors: R
authors: Inge
authors: Katherine M
authors: KM
authors: Newton
authors: Leslie
authors: L
authors: Spangler
authors: William E
authors: WE
authors: Barlow
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003442:Crowns / Q000706:statistics & numerical data; D003729:Dental Care / Q000706:statistics & numerical data*; D003777:Dental Prophylaxis / Q000706:statistics & numerical data; D017266:Dental Prosthesis / Q000706:statistics & numerical data; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D057747:Periodontal Debridement / Q000706:statistics & numerical data; D010510:Periodontal Diseases / Q000453:epidemiology; D012907:Smoking; D014081:Tooth Extraction / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology