Health care utilization and cost among health maintenance organization members with temporomandibular disorders.

AIMS: Little has been reported on the use of health care services and consequent costs among persons with temporomandibular disorders (TMD). This project compared the use and cost of medical and dental care services for TMD patients and matched comparison subjects. METHODS: Patients were continuously enrolled members of Kaiser Permanente Northwest Division who had at least 1 TMD Clinic visit or TMD-related procedure between January 1990 and December 1995 (n = 8,801). An equal number of comparison subjects were identified electronically and matched on 14 variables, including age and gender. Utilization and cost estimates were determined and compared for selected medical and dental services. RESULTS: For both groups, the mean age was about 40.5 years, and approximately 80% were female. The TMD subjects used significantly more services than did comparison subjects and had mean costs that were 1.6 times higher for all services. Outpatient visits accounted for about 40% of the difference in mean costs. About 10% of TMD subjects and comparison subjects accounted for about 40% and 47% of the costs in each group, respectively. Female TMD subjects and comparison subjects had higher costs than their male counterparts, and male TMD subjects had higher costs than female comparison subjects. CONCLUSION: Patients with TMD used more of all types of services and had higher costs. A small proportion of the subjects accounted for a large proportion of the costs. Gender was an important factor in utilization and cost. Utilization and cost differences were consistent over a wide range of service categories and could not be explained by TMD alone.

From repairing the consequences of disease to managed wellness: lessons from 20 years of managing dental care.

As the 21st century approaches, dentistry will be challenged by multiple pressures. The demographic trends of a growing population are outpacing the supply of dental manpower. Economic trends, including fewer family wage jobs, less full-time employment, and more single-parent families, create pressure on the ability to afford dental care. Competitive and reform pressures continue in the health-care field and are gaining momentum in dental care. Even without these pressures, traditional dental approaches have not been able to address the bulk of the needs of the population, as indicated by published assessments of the dental health of various segments or the overall use of dental services in the country. The challenge created by these demographic, economic, and competitive pressures on the KPDCP and the dental profession as a whole is to shift away from the individual patient, disease-model repair and improve management of dental wellness as the means of improving access to dental services for an even greater number of people. This challenge can be met by implementing the currently neglected clinical knowledge contained in our dental literature, taking action to find answers for the things we do not know, and by applying our knowledge to preventing the onset and/or progression of dental disease, decreasing unneeded and/or ineffective treatments, and avoiding premature entrance into the cycle of rerestoration.

Smokeless tobacco habits and oral mucosal lesions in dental patients.

As part of a smokeless tobacco (ST) intervention study, we collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Oral health data collection included grading the clinical appearance of oral mucosal lesions using Greer and Poulson's classification system, as well as identifying and recording the primary anatomic location of ST placement. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of smokeless tobacco placement. In a comparison sample of 223 non-ST-users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST use.