Acculturation and Children's dental service utilization in the United States.

OBJECTIVE: The study examined changes in acculturation level, socio-economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs. METHODS: Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross-sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio-economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator. RESULTS: Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio-economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization. CONCLUSION: Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio-economic status.

Test of an organizational change model to reduce no-shows in dental care settings.

OBJECTIVES: To test the feasibility and preliminary effectiveness of the NIATx model for organizational change to reduce appointment no-shows in dental care settings. METHODS: The NIATx Dental Pilot Study used a clustered prepost interventional design and a mixed-methods approach. Five independent dental clinics serving Medicaid enrollees were recruited. Quantitative data on the impact of the NIATx model were complemented by qualitative assessment information collected from dental staff. The NIATx model was applied through a multisite learning collaborative that engaged participating organizations in adopting targeted no-show best practices. The primary outcome measure was no-show data collected at the preintervention phase (5 months), intervention phase (7 months), and postintervention phase (3 months). RESULTS: Female patients were in the majority (median 54.5 percent). Mean age ranged from 8 to 50 (median 35.2) years. The median percentage for Hispanics was 11.0 percent, and the proportion of uninsured patients was 25 percent. Preintervention no-show rates ranged from 14 percent (clinic B) to 38 percent (clinic E). All clinics had lower no-show rates during the postintervention period, with decreases ranging from 1 percent (clinic B) to 13 percent (clinic E). Overall, the no-show rates decreased in the study. CONCLUSIONS: The study demonstrated the feasibility of applying the NIATx model to reduce no-show rates, with some difficulty observed with sustainability across dental practices during the postintervention period.

Dental service utilization and immigrant family structure.

OBJECTIVES: To determine the patterns and time trends of dental services received and access to dental care among immigrant and US-born children living in the United States. METHODS: We analyzed the nationally representative Medical Expenditure Survey data for 2007-2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received. RESULTS: Overall 34,482 children aged <18 years were included in the analysis representing the weighted sample size of 564,255,643. Utilization of preventive dental services increased from 37.2 percent in 2007 to 44.4 percent in 2015 overall (P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US-born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100-person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups. CONCLUSION: Stratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures.

Geographic variations in dental sealant utilization by Medicaid enrollees.

OBJECTIVE: To investigate geographical variations and their relationship to race/ethnicity in dental sealant utilization for first molars among Wisconsin Medicaid enrollees from 2010 to 2013. METHODS: Wisconsin Medicaid dental claims for sealants in children aged 6-16 years were analyzed. County-level population density, urban influence code, presence of dental health professional shortage areas, and population-per-dentist ratio were considered as geographic predictors. Descriptive statistics and mixed effects Poisson regression models were used to examine the effect of county level covariates on the number of dental sealants received per person-year (PY) of eligibility adjusting for patient-level characteristics. Over-dispersion was modeled by a random residual effect, and all models adjusted for single-year age and gender interaction and race/ethnicity main effect. RESULTS: Medicaid claims for sealants on first permanent molars for 2010-2013 totaled 288,019 over 1,130,000 PY. The age- and gender-standardized rate of first molar sealant applications per 100 PY were 27.9, 25.7, and 16.6 for White, Hispanic, and Black children, respectively. County-specific rates ranged from a low of 8.9 per 100 PY to a high of 62.6 per 100 PY. In the multivariate analysis after adjusting for geography, compared to Whites, Hispanics had highest rates (rate ratio (RR) = 1.33, 95% CI = 1.30-1.37) of dental sealant utilization followed by Blacks (RR = 1.25, 95% CI = 1.21-1.29). Population density was the only significant geographic predictor (RR = 0.56 per 10-fold increase, 95% CI = 0.45-0.69). CONCLUSIONS: Substantial geographic variability in the utilization of sealants for first molars was identified. Lower population density was the main geographical predictor of high sealant utilization.

Dental sealants and restorative treatment for first molars among Medicaid enrollees.

OBJECTIVES: To assess the association between dental sealant placement and subsequent restorative treatment of permanent first molars over time. METHODS: We analysed Wisconsin Medicaid claims data from 2001 to 2009 for children aged 6-16 years. Children entered the study cohort at age 6 and were censored if Medicaid eligibility was lost for >31 days. A fixed effects analysis via a Cox proportional hazards model, stratified by individual, was used to estimate the time-averaged and time-dependent effects of sealant placement on dental treatment defined as any restorative, endodontic or surgical procedure. RESULTS: A total of 185,262 children with permanent first molars who turned 6 years enrolled in Medicaid were examined. Sealant placement was higher for teeth #16 and 26 (5.42 and 5.46 per 100 person-years (100PY), versus 5.29 and 5.31/100PY for #36 and 46, respectively. The average rate for restorative treatments had the opposite pattern, with lower rate for teeth #16 and 26 (1.78 and 1.72/100PY) versus teeth #36 and 46 (2.14 and 2.12/100PY), respectively. In the fixed effects regression model, the hazard of dental treatment was substantially lower after sealant placement on a tooth, with time-averaged hazard ratio HR = 0.23 (95% CI 0.21-0.25, P < .001) versus before sealant. The largest effect was in the first year after sealant placement (HR = 0.13, 95% CI: 0.11-0.14), which decreased over time (HR = 0.50, 0.59 and 0.74 in years 2, 3 and 4, respectively), and was not statistically significant in later years. CONCLUSIONS: This study demonstrates that permanent first molar sealant placement delayed subsequent dental treatments in children enrolled in Medicaid.

Emergency department visits and dental procedures: Mission of Mercy, 2013-2016.

Objective: This study compared attendees at Wisconsin Mission of Mercy (MoM) events with and without prior emergency department (ED) visits for dental care in terms of demographic characteristics and dental procedures received. Methods: De-identified archival data available from the America's Dentists Care Foundation (2013-2016) were analyzed. Summary statistics were calculated based on prior ED visit status for county-level characteristics and type of dental procedures received. Generalized estimating equation models with logistic links were fitted to examine associations between the predictor and independent variables. Results: Most attendees were White, adult females (mean age 37 years). Current dental pain was reported by 61% vs 33% of attendees with and without prior ED visit. Cleaning (57%) was the most common procedure received by attendees with no prior ED visits, while extractions (47%) were the most common for those with prior ED visits. Among MoM attendees, males had higher odds of prior ED visits compared to females. Compared to White, Black had higher odds and Hispanic had lower odds of having prior ED visits. In the multivariable analysis, dental pain (OR: 3.32; 95% CI: 2.75, 4.02) had the strongest association with prior ED visits. Attendees with prior ED visit history had higher odds of receiving extractions and restorative care, compared to cleaning after adjustment for person and county-level characteristics. Conclusion: Among MoM attendees, prior ED visits were associated with not being Hispanic, being male, and having dental pain. Compared to attendees with no prior ED visit, those with prior ED visits had higher odds of receiving restorative care and extractions.

Hospital emergency department visits by ambulance for nontraumatic tooth pain in the USA.

OBJECTIVE: This study examined the prevalence of ambulance use for nontraumatic tooth pain (NTP) visit to emergency departments (EDs) and the factors associated with ambulance use for NTP in the USA. MATERIALS AND METHODS: Data from the National Hospital Ambulatory Medical Care survey conducted in the USA from 2003 to 2012 were analyzed. Descriptive statistics were obtained, and multivariable logistic regression was used to determine associations with ambulance use for NTP. RESULTS: The total proportion of ED visits due to NTP by ambulance was 1.1%, lowest in 2008 (0.43%) and highest in 2011 (2.28%). The proportion of ED visits due to NTP by ambulance was highest among public insurance enrollees (1.9%), Hispanics (2.3%) and those aged 45-64 years (2.7%). In the multivariable analysis, those aged 45-64 years had approximately four times higher odds of an ED visit for NTP by ambulance compared to those aged 25-44 years. CONCLUSION: This study demonstrates that transport to EDs by ambulance for NTP does occur at a measurable rate and adults aged 45-64 years had significantly higher odds of ED visits for NTP by ambulance.

Survival Rates of Stainless Steel Crowns and Multi-Surface Composite Restorations Placed by Dental Students in a Pediatric Clinic.

PURPOSE: This study examined survival rates of multi-surface composite restorations and stainless steel crowns (SSCs) placed by students in a pediatric dental clinic as well as the length of time it takes for restorations to be replaced with stainless steel crowns. STUDY DESIGN: Data from electronic dental records for all children with at least one 2-surface composite restorations or SSCs on a primary first or second molar from January 1, 2007 to September 30, 2015 were analyzed. The primary outcome was the time to a new restoration or SSC on the same tooth, with time to a crown as a secondary outcome. Descriptive statistics were obtained and the cumulative incidence of the event of interest was estimated using 95% confidence intervals and compared between groups using Fine-Gray regression. RESULTS: A total of 6,288 teeth from 2,044 children were analyzed. Three years after the initial procedure, 1.5% of SSCs and 21% of 2 and 3 surface composite restorations failed and needed a replacement (Hazard Ratio [HR]= 14; 95% Confidence interval [CI] 9-22, p<0.001). Also, 6.8% of composite restorations needed replacement with SSCs' (HR=4; 95% CI: 3-7). CONCLUSIONS: The study demonstrates that stainless steel crowns had a higher survival rate than multi-surface composite resins placed by students at a pediatric dental clinic in primary molars of children.

Trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States.

OBJECTIVE: The aim of this study was to examine trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States. METHODS: The US Medical Expenditure Panel Survey data for 1996-2013 was analyzed. Information on patient sociodemographic characteristics, dental visits, receipt of dental procedures, and type of antibiotics prescribed following visits was obtained. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to identify associations during the period with and without adjustment for dental procedures and sociodemographic characteristics. Survey weights were incorporated to handle the sampling design. RESULTS: Nationally, the number of antibiotic prescribed at dental visits was estimated to be higher by 842,749 (0.4 percent) at year 2013 compared to the prescription level at 2003 were the population sociodemographic distribution kept at 2013 level. On average, the odds of prescribing antibiotics following dental care increased with each decade of study (OR: 1.10; 95% CI: [1.04, 1.17]) after adjusting for sociodemographic characteristics and receipt of dental procedures. Compared to Whites, Blacks had 21 percent (95% CI: 11%, 31%) higher odds of receiving a prescription for antibiotics from a dentist after adjusting for dental procedure and other sociodemographic characteristics. CONCLUSIONS: The prescription of antibiotics following dental visits increased over time after adjustment for sociodemographic characteristics and dental procedure. The probability of being prescribed antibiotics by dentists was higher for Blacks compared to Whites.

Impact of Wisconsin Medicaid Policy Change on Dental Sealant Utilization.

BACKGROUND: In September 2006, Wisconsin Medicaid changed its policy to allow nondentists to become certified Medicaid providers and to bill for sealants in public health settings. OBJECTIVE: This study examined changes in patterns of dental sealant utilization in first molars of Wisconsin Medicaid enrollees associated with a policy change. DATA SOURCE: The Electronic Data Systems of Medicaid Evaluation and Decision Support for Wisconsin from 2001 to 2009. STUDY DESIGN: Retrospective claims data analysis of Wisconsin Dental Medicaid for children aged 6-16 years. PRINCIPAL FINDINGS: A total of 479,847 children followed up for 1,441,300 person-years with 64,546 visits were analyzed. The rate of visits for sealants by dentists increased significantly from 3 percent per year prepolicy to 11 percent per year postpolicy, and that of nondentists increased from 18 percent per year to 20 percent after the policy change, but this was not significant. Non-Hispanic blacks had the lowest visit rates for sealant application by dentists and nondentists pre- and postpolicy periods. CONCLUSIONS: The Wisconsin Medicaid policy change was associated with increased rates of visits for dental sealant placement by dentists. The rate of visits with sealant placements by nondentists increased at the same rate pre- and postpolicy change.

Travel distances by Wisconsin Medicaid enrollees who visit emergency departments for dental care.

OBJECTIVES: Prior studies document increased numbers of nontraumatic dental condition (NTDC) visits to U.S. emergency departments (EDs). However, the influence of travel distance on ED use for NTDCs, particularly for Medicaid enrollees has hitherto received little attention. The authors examined the effect of travel distance on Wisconsin Medicaid enrollees' NTDC visits to EDs after adjustment for covariates. METHODS: NTDC-related visits claims data for Wisconsin Medicaid (2001-2009) was analyzed. For each enrollee, travel distance to the nearest of 130 EDs in Wisconsin was determined. The number of NTDC visits per person-year was aggregated by ZIP+4 of residence. Negative binomial regression adjusting for the expected number of visits based on race, sex, age of the residents and calendar year was used to evaluate the effect of travel distance, urbanicity, and dentist-population ratio on rate of visits. RESULTS: Enrollees residing in rural counties, entire dental health professional shortage areas, areas with dentist population ratios >20,000: 1 and non-Hispanic Whites travelled the furthest, compared to nearest mean ED distance of 2.9 miles. Enrollees residing 3 miles away or further had significantly lower rates of NTDC visits to EDs. CONCLUSIONS: This study demonstrates that distance is a barrier to making NTDC-related visits to EDs. Rates of NTDC visits decreased as travel distance to the nearest ED increased for Medicaid enrollees.

Prescription of opioid analgesics for nontraumatic dental conditions in emergency departments.

BACKGROUND: Opioid analgesics prescribed for nontraumatic dental conditions (NTDCs) by emergency physicians continue to receive attention because of the associated potential for misuse, abuse and addiction. This study examined rates of prescription of opioid analgesics and types of opioid analgesics prescribed for NTDC visits in U.S. emergency departments. METHODS: Data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2010 were analyzed. Descriptive statistics and logistic regression analysis were performed and adjusted for the survey design. RESULTS: NTDCs made up 1.7% of all ED visits from 2007 to 2010. The prescription of opioid analgesics was 50.3% for NTDC and 14.8% for non-NTDC visits. The overall rate of opioid analgesics prescribed for NTDCs remained fairly stable from 2007 through 2010. Prescription of opioids was highest among patients aged 19-33 years (56.8%), self-paying (57.1%), and non-Hispanic Whites (53.2%). The probability of being prescribed hydrocodone was highest among uninsured patients (68.7%) and for oxycodone, it was highest among private insurance patients (33.6%). Compared to 34-52 year olds, children 0-4 years were significantly more likely to be prescribed codeine and less likely to be prescribed oxycodone. Compared to non-Hispanic Whites, non-Hispanic Blacks had significantly higher odds of been prescribed codeine and somewhat lower odds of been prescribed oxycodone, but it was not statistically significant. CONCLUSIONS: There was no significant change in the rates of opioid analgesics prescribed over time for NTDC visits to EDs. Age, payer type and race/ethnicity were significant predictors for the prescription of different opioid analgesics by emergency physicians for NTDC visits.

Dental service utilization and neighborhood characteristics in young adults in the United States: a multilevel approach.

OBJECTIVE: To investigate the association between neighborhood level factors and dental visits in young adults in the United States after adjusting for individual level factors. METHODS: The National Longitudinal Study of Adolescent Health Wave 1 (1994-1995) to Wave III (2001-2002) was analyzed. The primary outcome of having had at least one dental visit in the previous 12 months was analyzed via a multilevel random-effects logistic model accounting for geographic clustering in Wave III and survey design clustering from Wave I. Neighborhood level covariates were defined at the census tract level. RESULTS: Overall rate of dental visits was 57 percent, highest among 18-20 year olds (65 percent) and lowest in 23-26 year olds (52 percent). Increased proportion of African-Americans (≤5 percent to ≥20 percent) and Hispanics (≤5 percent to ≥20 percent) in a neighborhood corresponded with a decrease in dental visits (60 percent versus 52 percent) and (58 percent versus 51 percent), respectively. Neighborhoods with a high proportion of college-educated residents had a higher percentage of dental visits. Similar differences were found when comparing the lowest and highest tertiles defined by poverty level and unemployment with dental visits. Neighborhood education was significantly associated with dental service utilization after adjustment for individual level factors and dental utilization in adolescence (Waves I and II) in the random effects model. CONCLUSIONS: This study demonstrates that the education level of residents within a neighborhood was associated with dental service utilization in young adults in the United States.

Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey.

OBJECTIVES: The aim of this study was to examine trends and associated factors in the prescription of opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics by emergency physicians for nontraumatic dental condition (NTDC)-related visits. Our secondary aim was to investigate whether race/ethnicity is a possible predictor of receiving a prescription for either type of medication for NTDC visits in emergency departments (EDs) after adjustment for potential covariates. METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997-2000 and 2003-2007, and used multinomial multivariate logistic regression to estimate the probability of receiving a prescription for opioid analgesics, nonopioid analgesics, or a combination of both, compared with receiving no analgesics for NTDC-related visits. RESULTS: During 1997-2000 and 2003-2007, prescription of opioid analgesics and combinations of opioid and nonopioid analgesics increased, and that of no analgesics decreased over time. The prescription rates for opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics for NTDC-related visits in EDs were 43 percent, 20 percent, 12 percent, and 25 percent, respectively. Majority of patients categorized as having severe pain received prescriptions for opioids for NTDC-related visits in EDs. After adjusting for covariates, patients with self-reported dental reasons for visit and severe pain had a significantly higher probability of receiving prescriptions for opioid analgesics and opioid and nonopioid analgesic combinations. CONCLUSIONS: Prescription of opioid analgesics increased over time. ED physicians were more likely to prescribe opioid analgesics and opioid and nonopioid analgesic combinations for NTDC-related visits with reported severe pain.

Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care survey.

OBJECTIVE: To determine whether the rates of nontraumatic dental condition (NTDC)-related emergency department (ED) visits are higher during the typical working hours of dental offices and lower during night hours, as well as the associated factors. METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997 through 2007 using multivariate binary and polytomous logistic regression adjusted for survey design to determine the effect of predictors on specified outcome variables. RESULTS: Overall, 4,726 observations representing 16.4 million NTDC-related ED visits were identified. Significant differences in rates of NTDC-related ED visits were observed with 40%-50% higher rates during nonworking hours and 20% higher rates on weekends than the overall average rate of 170 visits per hour. Compared with 19-33 year olds, subjects < 18 years old had significantly higher relative rates of NTDC-related ED visits during nonworking hours [relative rate ratio (RRR) = 1.6 to 1.8], whereas those aged 73 and older had lower relative rates during nonworking hours (RRR = 0.4; overall P = 0.0005). Compared with those having private insurance, Medicaid and self-pay patients had significantly lower relative rates of NTDC visits during nonworking and night hours (RRR = 0.6 to 0.7, overall P < 0.0003). Patients with a dental reason for visit were overrepresented during the night hours (RRR = 1.3; overall P = 0.04). CONCLUSION: NTDC-related visits to ED occurred at a higher rate during nonworking hours and on weekends and were significantly associated with age, patient-stated reason for visit and payer type.

Racial and ethnic variations in waiting times for emergency department visits related to nontraumatic dental conditions in the United States.

BACKGROUND: Researchers have documented an association between waiting times in emergency departments (EDs) and quality of care for medical conditions, but little is known about trends and factors associated with waiting times for ED visits related to nontraumatic dental conditions (NTDCs). The authors examined trends in waiting time and associated factors for NTDC-related ED visits in the United States. METHODS: The authors analyzed data from the National Hospital Ambulatory Medical Care survey for 1997 to 2007, excluding 2001 and 2002 owing to lack of information about waiting times. The authors used a survey-weighted linear regression of log-transformed waiting-time model to determine the waiting time for NTDC-related visits. RESULTS: The geometric mean (standard error) waiting times for NTDC- and non-NTDC-related visits were 29 (1.0) and 25 (0.6) minutes, respectively (P < .01). The geometric mean waiting time for NTDC-related visits increased by 6 percent annually and from 20 minutes in 1997 to 37 minutes in 2007. Compared with whites, Hispanics and African Americans had significantly longer waiting times for NTDC-related visits (adjusted fold-difference [R] = 1.2, 95 percent confidence interval [CI] = 1.13-1.31) and [R] = 1.3, [CI] = 1.29-1.38). Age, payer type, reason for visit and triage category were significant predictors of waiting time (R = 2.3 and 2.4 for NTDC-related visits in the triage categories of more than one to two hours and more than two to 24 hours, respectively). CONCLUSION: Nationally, waiting times in EDs for NTDC-related visits increased over time. Compared with whites, Hispanics and blacks waited longer to receive care for NTDCs in EDs. PRACTICAL IMPLICATIONS: Prolonged waiting times associated with NTDC-related ED visits reinforce the need for dental professionals to continue to advise patients regarding the need to implement oral health preventive strategies and to avoid the use of the ED for preventable common dental conditions.

Predictors of dental care use: findings from the national longitudinal study of adolescent health.

PURPOSE: To examine longitudinal trends and associated factors in dental service utilization by adolescents progressing to early adulthood in the United States. METHODS: The data source was the National Longitudinal Study of Adolescent Health from Waves I (1994-1995), II (1996), III (2001-2002), and IV (2007-2008). This was a retrospective, observational study of adolescents' transition to early adulthood. We obtained descriptive statistics and performed logistic regression analyses to identify the effects of baseline and concurrent covariates on dental service utilization from adolescence to early adulthood over time. RESULTS: Dental service utilization within the prior 12 months peaked at age 16 (72%), gradually decreased until age 21 (57%), and remained flat thereafter. Whites and Asians had a 10-20 percentage points higher proportion of dental service utilization at most ages compared with Blacks and Hispanics. Dental service utilization at later follow-up visits was strongly associated with baseline utilization, with odds ratio = 10.7, 2.4, and 1.5 at the 1-, 7-, and 13-year follow-ups, respectively. These effects decreased when they were adjusted for current income, insurance, and education. Compared with Whites, Blacks were consistently less likely to report a dental examination. CONCLUSIONS: Dental service utilization was highest in adolescence. Gender, education, health insurance, and income in young adulthood were significant predictors in reporting a dental examination. Blacks had lower odds of reporting a dental examination, either as adolescents or as young adults.

Medications prescribed in emergency departments for nontraumatic dental condition visits in the United States.

BACKGROUND: Prior research has documented factors associated with nontraumatic dental condition (NTDC) visits to emergency departments (EDs), but little is known about the care received by patients in EDs for NTDC visits. OBJECTIVE: We examined national trends in prescription of analgesics and antibiotics in EDs for NTDC visits in the United States. RESEARCH DESIGN: We analyzed data from the National Hospital Ambulatory Medical Care survey from 1997 to 2007. We used a multivariable logistic regression model to examine factors associated with receiving analgesics and antibiotics for NTDC visits in EDs. RESULTS: Overall 74% received at least 1 analgesic, 56% received at least 1 antibiotic, and 13% received no medication at all during NTDC visits to EDs. The prescription of medications at EDs for NTDC visits steadily increased over time for analgesics (odds ratio=1.11/y, P<0.0001) and antibiotics (odds ratio=1.06/y, P<0.0001). In the multivariable analysis, self-pay patients had significantly higher adjusted odds of receiving antibiotics, whereas those with nondental reasons for visits and children (0-4 y) had significantly lower adjusted odds of receiving a prescription for antibiotics in EDs for NTDC visits. Children (0-4 y), adults (53-72 y), and older adults (73 y and older) had lower adjusted odds (P<0.001) of receiving analgesics. CONCLUSIONS: Nationally, analgesic and antibiotic prescriptions for NTDC visits to EDs have increased substantially over time. Self-pay patients had significantly higher odds of being prescribed antibiotics. Adults over 53 years and especially those 73 years and older had significantly lower odds of receiving analgesics in EDs for NTDC visits.

Patient characteristics and trends in nontraumatic dental condition visits to emergency departments in the United States.

OBJECTIVE: We examined trends and patient characteristics for non-traumatic dental condition (NTDC) visits to emergency departments (EDs), and compared them to other ED visit types, specifically non-dental ambulatory care sensitive conditions (non-dental ACSCs) and non-ambulatory care sensitive conditions (non-ACSCs) in the United States. METHODS: We analyzed data from the National Hospital Ambulatory Medical Care survey (NHAMCS) for 1997 to 2007. We performed descriptive statistics and used a multivariate multinomial logistic regression to examine the odds of one of the three visit types occurring at an ED. All analyses were adjusted for the survey design. RESULTS: NTDC visits accounted for 1.4% of all ED visits with a 4% annual rate of increase (from 1.0% in 1997 to 1.7% in 2007). Self-pay patients (32%) and Medicaid enrollees (27%) were over-represented among NTDC visits compared to non-dental ACSC and non-ACSC visits (P < 0.0001). Females consistently accounted for over 50% of all types of ED visits examined. Compared to whites, Hispanics had significantly lower odds of an NDTC visit versus other visit types (P < 0.0001). Blacks had significantly lower odds of making NDTC visits when compared to non-dental ACSC visits only (P < 0.0001). Compared to private insurance enrollees, Medicaid and self-pay patients had 2-3 times the odds of making NTDC visits compared to other visit types. CONCLUSION: Nationally, NTDC visits to emergency departments increased over time. Medicaid and self-pay patients had significantly higher odds of making NDTC visits.