Document Type


Date of Degree

Fall 2016

Degree Name

MS (Master of Science)

Degree In

Dental Public Health

First Advisor

Caplan, Daniel J.

First Committee Member

Momany, Elizabeth

Second Committee Member

Cunningham-Ford, Marsha

Third Committee Member

Marchini, Leonardo

Fourth Committee Member

Cowen, Howard

Fifth Committee Member

Bern-Klug, Mercedes


OBJECTIVE: To establish baseline data of dental utilization and determine the predictors of receipt of dental procedures by Medicaid-enrolled senior adults who reside in Iowa nursing facilities.

METHODS: This was a longitudinal retrospective analysis of Iowa Medicaid claims data for SFY 2007-2014 of senior adults who were 68 years or older upon entry to a nursing facility and continuously enrolled (eligible 58 out of 60 months) in Medicaid for three years prior to and at least two years after admission.

RESULTS: Controlling for the subject and nursing facility level variables, the strongest predictor of dental utilization after entry was the receipt of a dental procedure before entry (p< 0.001). Subjects residing in a facility located in an urban area (p< 0.002) or in two regions of Iowa (p=0.035, p=0.019, respectively) also had increased odds of receiving a dental procedure.

CONCLUSION: Our results show that approximately 50% of the subjects never received a dental procedure in the 5-year study period. The strongest predictor of receipt of dental procedures in the 2 years after entry was the receipt of dental procedures in the 3 years before entry. It is important for Medicaid-enrolled senior adults to establish a dental home while community-dwelling.

Public Abstract

Although there is a consensus among authors that oral health among institutionalized elderly patients are worse when compared to their community-dwelling peers, there are no published data for utilization of dental services by senior adults during their transition from community-dwelling to nursing facilities.

Many oral health programs are focusing on increasing access to oral health care for senior adults, however there is a lack of baseline utilization data for analysis of these programs. An objective of this study is to determine predictors of oral health care and establish baseline data for Medicaid-enrolled senior adults.

The present study shows that over half of Iowa Medicaid-enrolled senior adults never received an oral exam or oral hygiene procedure in 5 years while transitioning from community-dwelling to nursing facility residence.


dental utilization, frail elderly, preventive dental


xii, 87 pages


Includes bibliographical references (pages 80-87).


Copyright © 2016 Mary C. Kelly Grief