DOI

10.17077/etd.5170ki8m

Document Type

Thesis

Date of Degree

Spring 2017

Access Restrictions

Access restricted until 07/13/2019

Degree Name

MS (Master of Science)

Degree In

Dental Public Health

First Advisor

McKernan, Susan C.

First Committee Member

Avila-Ortiz, Gustavo

Second Committee Member

Cunningham-Ford, Marsha

Third Committee Member

Damiano, Peter

Fourth Committee Member

Qian, Fang

Abstract

Objective: To investigate and determine periodontal treatment needs by the use of the Community Periodontal Index of Treatment Needs (CPITN) of a Medicaid expansion population in the state of Iowa (DWP) in comparison with patients insured by the traditional Medicaid State Plan, patients with private dental insurance, and self-pay patients, while evaluating for systemic health conditions and socio-behavioral factors.

Methods: A secondary data analysis of electronic health records (EHR) from the University of Iowa College of Dentistry was completed and analyzed. Univariate and bivariate analyses were conducted. Logistic regression models were used to analyze relationships between predictors and periodontal treatment need.

Results: Out of the study population, 54% were indicated for scaling and root planing (SRP). Predictors of indicating the need for SRP treatment were found to be: Age (p< .0001), gender (p< .0001), medical diagnosis of diabetes (p=.031), smoking status (p< .0001), and not receiving regular dental check-ups (p< .0001).

Discussion: Our findings are consistent with common periodontal disease predictors found in the literature. Interestingly, insurance status was not a significantly associated predictor of periodontal treatment needs. However, approximately 50% patients with all insurance types were indicated for SRP.

Implications: DWP patients must earn benefits by maintaining dental appointments. This earned benefits approach delays periodontal treatment as patients must earn this procedure, potentially leading to deteriorating periodontal health. Further assessment of periodontal burden in the DWP population should be conducted and potential program structure evaluated.

Public Abstract

Lack of routine dental care can lead to oral complications. Recent studies connected periodontal disease with other health concerns such as cardiovascular diseases and diabetes. With new evidence linking periodontal disease and serious health problems, it becomes concerning that approximately 50% of the U.S. population suffers from the disease.

The Dental Wellness Plan (DWP) is part of Iowa’s Medicaid expansion program providing dental coverage to low-income adults not categorically eligible for Medicaid. DWP patients must “earn” benefits by maintaining dental appointments. This earned benefits approach delays periodontal treatment as patients must earn this procedure, potentially worsening disease.

This study was a secondary data analysis of electronic health records (EHR) at the University of Iowa College of Dentistry. It assessed periodontal treatment needs by determining whether an individual required periodontal disease treatment or routine dental cleaning. It also explored the relationships that exist between treatment need, systemic health conditions, and socio-behavioral factors among DWP in comparison with other insurance types.

It was found that 54% were indicated for periodontal treatment. Predictors of SRP need were found to be: Age (p<.0001), gender (p<.0001), diagnosis of diabetes (p=.031), smoking status (p<.0001), and not receiving regular dental check-ups (p<.0001).

Interestingly, insurance status was not significantly associated with periodontal treatment needs. However, approximately 50% of patients with all insurance types were indicated for SRP. While a large portion of the study population were indicated for periodontal therapy, delaying of treatment in the DWP program could exasperate systemic health and worsen periodontal health of these individuals.

Keywords

CPITN, Dental Wellness Program, earned benefits, Medicaid expansion, Periodontal disease, Periodontitis

Pages

xiii, 101 pages

Bibliography

Includes bibliographical references (pages 95-101).

Copyright

Copyright © 2017 Jennifer Michelle Cecelia Sukalski

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