Study: cost, lack of insurance coverage are primary predictors of poor oral health

One in five adults in Wisconsin is not receiving needed oral-health care and an estimated 15 percent have cavities.

These results, the product of a collaborative study between the University of Wisconsin-Madison and the Wisconsin Department of Health Services, are from one of the most thorough oral-health screenings of a state population to date. Based on the study’s findings, researchers found oral-health inequities are spread across a number of community-level and economic factors, with the biggest deterrent to care being cost.

Data were collected through the Wisconsin Department of Health Services Oral Health Screening project in partnership with the Survey of the Health of Wisconsin. SHOW collects data from an annual representative sample of Wisconsin residents via in-person interviews, questionnaires and physical examinations. The DHS Oral Health Screening program provided funding and trained field staff to conduct an objective oral screening of approximately 1000 state residents.

During the study period, the age of participants ranged from 21-74 years old. As part of SHOW, 85 percent of those surveyed from 2010 to 2011 also participated the Oral Health Screening Project, which included a visual examination to assess the oral-health burden and needs of 1,453 participants.

More than 58 percent of participants indicated they had unmet dental-care needs because they couldn’t afford costs. The majority of those with unmet dental needs also reported either a lack of insurance (44.9 percent), or that their insurance did not cover needed care (14.6 percent). About 16 percent stated it was because they did not like or they feared dentists.

Of those who reported unmet health-care needs, more than 47.7 percent of individuals had no health insurance; 29.4 percent had some public insurance including Medicaid, Medicare and/or private insurance; and 12.8 percent had only private insurance.

The proportion of untreated cavities was greatest among individuals who had a high school education or less (24.3 percent); identified as non-white (22.6 percent); were single (20.9 percent); had no health insurance (32.8 percent) or had a family income less than 100 percent of the federal poverty line (32 percent).

Sociodemographic data collected included age, race/ethnicity, marital status, education and insurance status. Economic hardship was measured based on total family income and federal poverty levels. Preventive oral health behaviors included self-reported frequency of teeth-brushing and frequency of flossing. Psychosocial factors included self-reported depression, anxiety and stress, and community-level measures included group-level estimates of socioeconomic status and the density of primary care providers.

While not causal, poor oral health correlates with an increased use of medical devices, risk of chronic conditions like heart disease and diabetes, reduced quality of life and fewer employment opportunities.

The study adds to the growing volume of work investigating the social, economic and environmental factors that impact health disparities.

“The findings are significant because they suggest oral-health disparities are pervasive,” said Kristen Malecki, assistant professor of population health sciences at the UW School of Medicine and Public Health.

The current Affordable Care Act doesn’t include provisions for increasing access for oral health care. However, changes in insurance coverage for primary care suggest increasing emphasis on oral-health prevention to medical treatment — including emphasizing importance and value of teeth-brushing in primary care visits — may be an opportunity for achieving health equity and addressing what the Surgeon General has called a ‘silent epidemic’ sweeping the nation.”

The full study is available online, published by the American Journal of Public Health.

The Wisconsin Partnership Program in the UW School of Public Health and the National Institute of Health provided funding for the SHOW data collection.

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