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The Southeastern District of the Massachusetts Dental Society is one of 13 different district dental societies in Massachusetts. Our current membership includes over 260 dentists practicing in Southeastern Massachusetts. This website is intended primarily as an informational resource for district members, however, if you are a patient, we have arranged some useful links in the column to the right, including a dentist search.
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Survey identifies top stress factors for dentists
Running behind schedule and constant time pressures are the top stress factors for dentists . . . keep reading >>
Busting UCR
Well, they finally did it! After years of member frustration and complaints, the ADA last August filed a class-action lawsuit against one of the country's major dental insurance carriers . . . keep reading >>
Profiling
Profiling is a buzzword since the terrorists attacked the World Trade Center. No doubt some recipients of profiling have suffered undeserved inconveniences . . . keep reading >>
Digital photography: the key to esthetic awareness
Digital photography can show patients the solutions before, during and after procedures . . . keep reading >>
Potassium nitrate, fluoride can reduce tooth sensitivity in at-home bleaching
The addition of potassium nitrate and fluoride to a carbamide peroxide bleach can reduce the tooth sensitivity experienced during at-home bleaching . . . keep reading >>
Trustee's Report
Dr. Milton Glicksman
After initial consternation due to 9/11, the attendance at Yankee turned out to be quite good. Probably over 25,000, but more importantly it was a buying crowd . . . keep reading >>
Chairman's Report
Dr. Paul Raymond
The Executive Committee would like to announce that the Southeastern District Dental Society has awarded two $250.00 scholarships to two deserving young ladies . . . keep reading >>
Patient-centered practice is easily achievable
Making a dental office patient-centered is complex but easily achievable, writes dental consultant Linda L. Miles . . . keep reading >>
Fellowships encourage dental teaching careers
Educator fellowships are becoming more prevalent as the dental profession seeks new ways to increase the number of practitioners who pursue careers in teaching . . . keep reading >>
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Dental Service Use and Dental Insurance Coverage -- US, ...
December 19, 1997 / 46(50);1199-1203
Dental Service Use and Dental Insurance Coverage -- United States, Behavioral Risk Factor Surveillance System, 1995
In the United States, 94% of adults have evidence of past or
current tooth decay, and only one third of adults aged 35-44 years
have all of their permanent teeth (1). Dental insurance is
associated with increased use of dental services and improved oral
health status (2,3). This report summarizes state-specific and
aggregated state data on both private and public sources of dental
insurance coverage and the use of dental services among adults in
25 states * who participated in the oral health module of the 1995
Behavioral Risk Factor Surveillance System (BRFSS). The findings
indicate that nearly half (44.3%) of adults in this survey reported
having no dental insurance coverage.
The BRFSS is a continuous, state-based, random-digit-dialed
telephone survey of the U.S. noninstitutionalized population aged
greater than or equal to 18 years. In 1995, a total of 56,339
adults participated in the core BRFSS in the 25 states that
included the oral health module. State response rates ranged from
52.3% to 84.5% (median: 68.4%). Participants were asked whether
they had had a dental visit within the previous 12 months (a
past-year visit), one of the national health objectives for the
year 2000 for oral health (objective 13.4) (4); reasons for not
having had a past-year visit; and whether they had any kind of
insurance coverage that pays for some or all of their dental care,
including dental insurance, prepaid plans such as
health-maintenance organizations (HMOs), or government plans such
as Medicaid. Persons who reported having no dental-care coverage at
the time of the interview were considered to be uninsured. Weighted
prevalence estimates and 95% confidence intervals (CIs) were
calculated by sex, age, education level, annual household income,
and dentate status (i.e., the presence or absence of natural teeth:
edentate=no teeth, dentate=one or more teeth) by SUDAAN.
Of respondents to the core BRFSS questionnaire, 93.3%
participated in the oral health module. Of these, 69.0% (95%
CI=plus or minus 0.8 percentage points) reported having had a
past-year dental visit (range: 61.4% {Arkansas} to 74.5%
{Wisconsin}) ( Table_1 ). Women were more likely than men to
report
having had a past-year visit (70.7% {95% CI=plus or minus 1.0
percentage points} and 67.1% {95% CI=plus or minus 1.2 percentage
points}, respectively) ( Table_2 ). The highest prevalences of
such
visits were among dentate adults aged greater than or equal to 65
years (75.0%) and all persons aged 35-44 and 45-54 years; the
lowest prevalences were among edentate adults aged greater than or
equal to 65 years (18.5%). The percentage of adults reporting a
past-year visit varied directly with education levels and family
incomes. The prevalence of a past-year visit was higher among
insured adults than among uninsured adults (78.3% compared with
57.6%) and higher among dentate adults than among edentate adults
(72.5% compared with 24.3%).
A total of 44.3% (95% CI=plus or minus 0.8 percentage points)
of participants reported being uninsured at the time of interview
(range: 31.8% {Alaska} to 60.4% {Maine}) ( Table_1 ). This
proportion
was similar for both men (43.5% {95% CI=plus or minus 1.2
percentage points}) and women (45.2% {95% CI=plus or minus 1.0
percentage points}) ( Table_2 ). The percentage of uninsured
persons
was lowest among persons aged 35-44 years and 45-54 years and
highest among persons aged greater than or equal to 65 years and
varied inversely with education level and family income. In
addition, the likelihood of being uninsured was higher among
edentate adults than dentate adults (67.1% compared with 42.4%) and
higher among adults whose last dental visit was greater than or
equal to 5 years ago than those with a past-year visit (69.4%
compared with 36.5%).
The two most common reasons cited by respondents who did not
have a past-year visit were that they did not perceive they had a
dental problem (44.6%) and cost (26.6%). Among edentate adults,
however, 89.5% did not perceive a problem, and 2.5% cited cost as
a reason for not having had a past-year visit. Similar percentages
of insured respondents (42.9%) and uninsured respondents (45.6%)
did not perceive the need to visit a dentist. However, 36.0% of
uninsured adults cited cost as the reason for not having had a
past-year visit compared with 11.9% of insured adults.
Reported by: J Cook, MPA, Alabama; P Owen, Alaska; B Bender,
Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; E
Pledger, MPA, Georgia; C Johnson, MPH, Idaho; B Steiner, MS,
Illinois; N Costello, MPA, Indiana; A Wineski, Iowa; D Maines,
Maine; D Brooks, MPH, Massachusetts; P Smith, Montana; T Melnik,
DrPH, New York; J Kaske, MPH, North Dakota; R Indian, MS, Ohio; J
Grant-Worley, MS, Oregon; J Hesser, PhD, Rhode Island; K Condon,
Texas; R Giles, Utah; R McIntyre, PhD, Vermont; L Redman, Virginia;
K Wynkoop-Simmons, PhD, Washington; E Cautley, MS, Wisconsin; M
Futa, MA, Wyoming. Behavioral Surveillance Br, Div of Adult and
Community Health; Surveillance, Investigations, and Research Br,
Div of Oral Health, National Center for Chronic Disease Prevention
and Health Promotion, CDC. Editorial Note
Editorial Note: The BRFSS oral health module generates
state-specific estimates that for the first time document variation
in past-year dental visits and dental insurance coverage for adults
in participating states. Overall, state-specific prevalences of
persons reporting a past-year visit varied inversely with
prevalences of persons without dental insurance. This association
is consistent with results of the National Health Interview Survey
(2) and other previously published studies (5,6). However, in some
states (e.g., Massachusetts, Ohio, and Vermont), use was high
despite lower percentages of dental insurance coverage. Such
differences may reflect differences in age distribution, income, or
education level of adults in these states. Twelve states exceeded
the national health objective of greater than or equal to 70% of
adults aged greater than or equal to 35 years using the
oral-health-care system during each year (4).
Among specific population groups (e.g., younger and older age
groups, lower income or education level groups, or edentate
persons), lower percentages of adults reported dental insurance
coverage and dental services use. Because dental insurance
typically is provided as an employee benefit, groups less likely to
have dental insurance include young adults and elderly retired
persons. Overall, uninsured adults were three times more likely
than insured adults to cite cost as the main reason for not having
had a past-year visit. Infrequent use of dental services has been
associated with poor oral health among adults with lower income and
education levels; such persons have more decayed teeth requiring
treatment, more severe periodontal disease, and are more likely to
be edentate than adults with more education and higher incomes (7).
Regardless of insurance status, however, almost half the adults who
did not have a past-year visit in 1995 did not perceive the need
for one. This finding was particularly evident among edentate
adults and is of concern because adults without teeth are older,
and the incidence of oral cancers that could be detected during an
oral examination is higher among older adults (8-10).
Interpretations of these survey results are subject to at
least two limitations. First, because the BRFSS does not include
households without a telephone, these findings may underestimate
the prevalence of being uninsured in some population groups (e.g.,
lower income or education level). Second, adults who are eligible
for Medicaid or who have Medicare who reported having dental
insurance may not be aware that coverage for many dental services
may be limited or nonexistent.
The BRFSS can provide routinely available, timely,
state-specific data on reported use of dental services and dental
insurance coverage that may be used for monitoring trends over time
and the effects of changes in the dental health-care delivery
system. Changes may include the provision of coverage of some
dental services offered to Medicare beneficiaries by HMOs;
increasing proportions of the population, including those eligible
for Medicaid, covered by managed-care versus fee-for-service dental
insurance plans; and increases in the price of dental services
relative to the Consumer Price Index. The BRFSS also can serve as
the basis for planning and evaluating oral health promotion and
disease prevention programs. Such programs are designed to enhance
knowledge and behaviors that can maintain and improve oral health
(e.g., routine oral examinations and primary and secondary
prevention services).
References
National Center for Health Statistics. Healthy people 2000
review, 1995-96. Hyattsville, Maryland: US Department of Health
and
Human Services, Public Health Service, CDC, 1996.
Bloom B, Gift HC, Jack SS. Dental services and oral health:
United States, 1989. Hyattsville, Maryland: US Department of
Health
and Human Services, Public Health Service, CDC, 1992:8-11; DHHS
publication no. (PHS)93-1511. (Vital and health statistics;
series
10, no. 183).
Damiano PC, Shugars DA, Johnson JD. Expanding health insurance
coverage and the implications for dentistry. J Public Health
Dent
1992;52:52-8.
Public Health Service. Healthy people 2000: national health
promotion and disease prevention objectives -- full report,
with
commentary. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1990; DHHS publication no.
(PHS)91-50212.
Manning WG, Bailit HL, Benjamin B, Newhouse JP. The demand for
dental care: evidence from a randomized trial in health
insurance.
J Am Dent Assoc 1985;110:895-902.
Grembowski D, Conrad D, Milgrom P. Utilization of dental
services in the United States and an insured population. Am J
Public Health 1985;75:87-9.
Chen M-S. Oral health of disadvantaged populations. In: Cohen
LK, Gift HC, eds. Disease prevention and oral health promotion:
socio-dental sciences in action. Munksgaard, Copenhagen:
Federation
Dentaire International, 1995:153-212.
CDC/National Institutes of Health. Cancers of the oral cavity
and pharynx: a statistics review monograph, 1973-1987. Atlanta,
Georgia: US Department of Health and Human Services, Public
Health
Service, 1991.
Silverman S Jr. Oral cancer. Atlanta, Georgia: American Cancer
Society, 1985.
US Preventive Services Task Force. Guide to clinical preventive
services: report of the US Preventive Services Task Force. 2nd
ed.
Baltimore, Maryland: Williams & Wilkins, 1996:175-80.
Alabama, Alaska, Arizona, Arkansas, California, Georgia, Idaho,
Illinois, Indiana, Iowa, Maine, Massachusetts, Montana, New York,
North Dakota, Ohio, Oregon, Rhode Island, Texas, Utah, Vermont,
Virginia, Washington, Wisconsin, and Wyoming.
Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 1. Weighted percentage of persons reporting a dental visit during the previous 12 months and
persons reporting having no dental insurance, by state -- United States, Behavioral Risk Factor
Surveillance System, 1995 *
====================================================================================================
Dental visit No dental
during previous 12 insurance
months
------------------------ --------------------------
State % (95% CI+) % (95% CI)
----------------------------------------------------------------------------------------------------
Alabama 64.1 (+/-2.7%) 49.8 (+/-2.8%)
Alaska 73.3 (+/-3.2%) 31.8 (+/-3.2%)
Arizona 66.5 (+/-3.2%) 43.9 (+/-3.2%)
Arkansas 61.4 (+/-2.6%) 55.4 (+/-2.6%)
California 66.5 (+/-2.4%) 43.7 (+/-2.3%)
Georgia 71.8 (+/-2.2%) 36.4 (+/-2.3%)
Idaho 65.9 (+/-2.0%) 46.6 (+/-2.1%)
Illinois 73.5 (+/-2.6%) 39.4 (+/-3.1%)
Indiana 65.2 (+/-2.2%) 43.7 (+/-2.2%)
Iowa 68.1 (+/-1.8%) 46.0 (+/-1.9%)
Maine 66.0 (+/-3.0%) 60.4 (+/-3.1%)
Massachusetts 74.2 (+/-2.3%) 46.0 (+/-2.6%)
Montana 65.6 (+/-3.0%) 57.3 (+/-3.1%)
New York 71.1 (+/-3.3%) 44.5 (+/-3.4%)
North Dakota 68.9 (+/-2.4%) 58.8 (+/-2.7%)
Ohio 73.9 (+/-2.7%) 47.3 (+/-3.2%)
Oregon 70.8 (+/-1.9%) 41.1 (+/-2.0%)
Rhode Island 69.2 (+/-2.5%) 43.2 (+/-2.6%)
Texas 65.1 (+/-2.7%) 47.0 (+/-2.7%)
Utah 73.3 (+/-2.2%) 39.5 (+/-2.5%)
Vermont 73.0 (+/-2.0%) 48.3 (+/-2.3%)
Virginia 73.5 (+/-2.4%) 40.8 (+/-2.6%)
Washington 68.8 (+/-1.8%) 40.6 (+/-1.9%)
Wisconsin 74.5 (+/-2.3%) 42.0 (+/-2.6%)
Wyoming 66.4 (+/-2.2%) 46.3 (+/-2.3%)
Total 69.0 (+/-0.8%) 44.3 (+/-0.8%)
----------------------------------------------------------------------------------------------------
* n=56,339. Excludes persons who said they did not know or who refused to respond.
+ Confidence interval.
====================================================================================================
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TABLE 2. Weighted percentage of persons reporting a dental visit during the previous 12 months and persons
reporting having no dental insurance, by selected characteristics -- United States, Behavioral Risk Factor
Surveillance System, 1995 *
=============================================================================================================
Dental visit No dental
during previous 12 insurance
months
---------------------------- ---------------------------
Characteristic % (95% CI+) % (95% CI)
-------------------------------------------------------------------------------------------------------------
Sex
Men 67.1 (+/-1.2%) 43.5 (+/-1.2%)
Women 70.7 (+/-1.0%) 45.2 (+/-1.0%)
Age group (yrs)
18-24 67.4 (+/-2.5%) 44.3 (+/-2.7%)
25-34 67.1 (+/-1.6%) 39.8 (+/-1.8%)
35-44 72.5 (+/-1.8%) 34.2 (+/-1.8%)
45-54 75.0 (+/-1.8%) 35.9 (+/-2.2%)
55-64 69.8 (+/-2.0%) 49.7 (+/-2.2%)
>=65 61.6 (+/-1.6%) 69.3 (+/-1.8%)
Education level (yrs)
<12 50.0 (+/-2.2%) 63.4 (+/-2.2%) 12 66.4 (+/-1.4%) 47.9 (+/-1.4%)>=13 75.6 (+/-0.9%) 36.9 (+/-1.0%)
Annual household income
<$15,000 51.2 (+/-2.5%) 67.2 (+/-2.5%) $15,000-$24,999 59.2 (+/-1.8%) 61.0 (+/-1.8%) $25,000-$34,999 67.6 (+/-1.8%) 43.4 (+/-1.8%)>=$35,000 79.4 (+/-1.0%) 28.2 (+/-1.2%)
Insurance status
Insured 78.3 (+/-1.0%) --
Uninsured 57.6 (+/-1.2%) --
Dentate status&
Edentate 24.3 (+/-2.3%) 67.1 (+/-2.5%)
Dentate 72.5 (+/-0.4%) 42.4 (+/-0.4%)
Time since last visit
<=1 year 36.5 (+/-1.0%)>=5 years -- 69.4 (+/-2.5%)
Total 69.0 (+/-0.8%) 44.3 (+/-0.8%)
-------------------------------------------------------------------------------------------------------------
* n=56,339. Excludes persons who said they did not know or who refused to respond.
+ Confidence interval.
& Edentate=no teeth, dentate=one or more teeth.
=============================================================================================================
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