Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Janice C. Probst


Background Poor oral health had been associated with increased risk of having systemic diseases and thus mortality. The purpose of this research was to find if dental coverage with health insurance could mitigate the risk of death due to untreated dental caries and periodontitis among working age U.S. adults. Methods Data were drawn from NHANES III (1988-1994) and linked to mortality updated till Dec. 31st, 2011. It was restricted to those in the age range of 20-64 years adults. Furthermore, it was restricted to those who had complete data collection on all measures. Unweighted propensity scores were calculated to control for the differential proportion of dental coverage in the population separated by gender. The continuous propensity score obtained was converted into quartiles based on the population distribution of both males and females to ascertain the risk of mortality based on low to high probability of dental coverage. All analyses were weighted and adjusted for complex sampling of NHANES III survey using proc survey procedures in SAS v9.4 for each gender. Andersen’s model of health care utilization was used as a basis for the addition of incremental variables in the models. Results Nearly 10% deaths among males and 7% among females were observed in our sample. Observed deaths were more in those who had increased number of decayed teeth and periodontitis. Similarly, those who had dental coverage with health insurance had fewer deaths as compared to those without dental coverage. Multivariate analyses showed that people who have increased number of decayed teeth had a higher risk of mortality in both males and females. Only among females, all the propensity quartiles had a protective effect on the risk of mortality in associations with dental decay in the final model. Periodontitis was linked to higher risk of mortality in simplified analyses and the risk reduced with the introduction of dental insurance and dental insurance propensity score. However, in both dental caries and periodontitis for both males and females, dental insurance remained insignificant in the final (full) model but the propensity score for dental coverage in females only. Conclusion The dental coverage was not significant in the full models for both dental caries and periodontitis among males and females. Additionally, we did not have any information available on the depth of dental coverage and out of pocket costs associated with dental coverage. However, we do know that access to preventive and curative dental services is guaranteed by dental coverage, therefore, dental coverage should be a mandatory part of health insurance under Medicaid expansion and health care reforms but with little or no financial contribution in the form of co-payments and deductibles for the customer. It is evident from RAND Health Insurance Experiment that improved oral and dental health was seen among those who had free or nominal financial contribution. In future, national surveys should incorporate in-depth details about dental coverage for both out of pocket costs and treatments provided.

Available for download on Wednesday, December 20, 2017