Chartbook #17: Dental Use, Expenses, Dental Coverage, and … · 2020-03-06 · t t Dental Use, Expenses, Dental Coverage, and Changes, M EPS Charbook N o.17 M edicalExpendiure PanelSurvey

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Dental Use, Expenses, Dental Coverage, and Changes,

M EPS Charbook N o.17 M edicalExpendiure PanelSurvey

1996 and 2004

Community Children: Adults: Older Adults: Population Birth–Age 20 Age 21–64 Age 65 and over

Agency for Healthcare Research and Quality U.S. Department of Health & Human Services

The estimates in this report are based on the most recent data available from MEPS at the time the report was written. However, ta may be revised on the basis of additional analyses, which could result in slightly different

ere. Please check the MEPS Web site (www.meps.ahrq.gov) for the most current file releases.

ncy charged with supporting research designed to improve the quality of health care, reduce its cost, ical errors, and broaden access to essential services. AHRQ sponsors and conducts research that mation on health care outcomes; quality; and cost, use, and access. The information helps health ts and clinicians, health system leaders, and policymakers—make more informed decisions and care services.

MEPS Chartbook No. 17

Richard J. Manski, DDS, MBA, PhD Erwin Brown, Jr., BS

ental Use, Expenses, Private Dental Coverage, and Changes, 1996 and 2004. Rockville (MD): h and Quality; 2007. MEPS Chartbook No.17. http://www.meps.ahrq.gov/mepsweb/data_files/

selected elements of MEPS daestimates from those shown h AHRQ is the lead Federal ageaddress patient safety and medprovides evidence-based inforcare decision makers—patienimprove the quality of health

Suggested citation: Manski, R. J. and Brown, E. DAgency for Healthcare Researcpublications/cb17/cb17.pdf

www.meps.ahrq.gov

Executive Summary

Community Population

Forty-four percent of the community population had a dental visit in 2004. The average annual expense for persons with a visit was $560, and the average number of visits per person for persons with a visit was 2.5. (4)

Fifty-eight percent of persons from a high-income family had at least one dental visit during the year; only 30% of persons from a family with low income had at least one dental visit during the year. (7)

Black non-Hispanic and Hispanic persons were less likely to have a dental visit in 2004 than white non-Hispanic persons or persons of other race/ethnicity categories. (8)

While 57% of those with private dental coverage had a visit during 2004, 32% with public dental coverage only and 27% with no dental coverage had a visit. (13)

Overall, there was no change in the percentage of the population with a dental visit. The average number of dental visits per person for those with a dental visit decreased from 1996 to 2004. (16, 20)

The average dental expenses increased from $374 ($450 adjusted for inflation) in 1996 to $560 in 2004. For each age and income category, the average expense increased. (20, 24)

Children: Age Birth–20

The likelihood of a visit varied by age, with approximately 25% of children under age 6 but 59% of children age 6-12 years old having a visit. (39)

Overall, high-income children were twice as likely to have a visit as poor children. (39)

Black non-Hispanic and Hispanic children were more likely to have public dental coverage and less likely to have private dental coverage in 2004 than white non-Hispanic children or children of other race/ethnicity categories. Overall, children with private dental coverage were twice as likely to have had a dental visit as children with no dental coverage. (44, 45)

The average annual expense for children with a visit was $635 for a child with private dental coverage and $272 for a child with public dental coverage only during 2004. (46)

Medical Expenditure Panel Survey page i

Younger children, low-income children, black non-Hispanic children, Hispanic children, and children with public dental coverage only experienced an increase in the likelihood of a dental visit from 1996 to 2004. (50, 51, 52)

The percentage of children with public dental coverage only increased from 1996 to 2004. The percentage of children with no dental coverage decreased from 1996 to 2004. (64)

Poor, low-income, and middle-income children were much more likely to have public dental coverage only and less likely to have no dental coverage in 2004 than in 1996.(66)

Adults: Age 21–64

Among adults, the likelihood of having a dental visit varied by age, family income, race/ethnicity, and education. While 56% of adults with high income had a visit, only half as many (27%) with low income had at least one dental visit during 2004. (73, 74)

About 60% of adults (age 21-64) had private dental coverage, and 34% of adults had no dental coverage during 2004. (76)

Adults from a poor family were almost three times more likely to have no dental coverage as one from a high-income family, (59% and 21%, respectively). (77)

In 2004, 56% of the adult population with private dental coverage had a dental visit, 28% of the adult population with public dental coverage only had a dental visit, and 22% of adults without any dental coverage had a dental visit. (79)

Adults without dental coverage had a statistically significant decrease in the likelihood of having a dental visit from 1996 to 2004. (85)

Average dental expenses increased from $361 ($434 adjusted for inflation) in 1996 to $556 in 2004. (86)

Older Adults: Age 65 and Older

Among older adults, approximately 46% age 65-74 and 39% age 75 and over had at least one dental visit. (105)

While 60% of older adults from a high-income family had at least one dental visit during the year, less than 31% of older adults from a poor or low-income family had at least one dental visit during the year. (105)

Approximately 70% of older adults did not have any dental coverage in 2004. (108)

Older adults with public dental coverage only were more likely to have a dental visit in 2004 than 1996. (117)

Average dental expenses increased from $438 ($527 adjusted for inflation) in 1996 to $620 in 2004. (118)

Medical Expenditure Panel Survey page ii

Foreword

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The Medical Expenditure Panel Survey (MEPS) helps AHRQ fulfill its mission by providing information on health care use and expenses, health insurance, health status, and a variety of demo-graphic, social, and economic characteristics. MEPS is a set of large-scale surveys of families and indivi-duals, their medical providers, and employers across the United States. MEPS provides various ways of accessing the data so that it can be most useful to you. The MEPS Web site (http://www.meps.ahrq.gov) has • Online publications to read or download • MEPS public use data files that you can review and

download • MEPSNet, which allows analysis of MEPS data

using online statistical tools • Tables showing MEPS data displayed by some of

the most frequently used characteristics

AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this chartbook and other MEPS data and tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. Please e-mail us at [email protected] or send a letter to the address below: Steven B. Cohen, PhD Director Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850

Overview: Medicare/Non-Medicare

Medical Expenditure Panel Survey page iii

http://www.meps.ahrq.gov/

Acknowledgments

We wish to thank Jessica Banthin, Karen Beauregard, Joel Cohen and Steven Cohen for their comments on an earlier draft; and Devi Katikineni and Zhengyi Fang of Social & Scientific Systems, Inc., Silver Spring, Maryland, who provided skillful computer programming support. We also wish to thank Burton L. Edelstein, DDS, MPH, Professor and Director, Division of Community Health, Columbia University School of Dental and Oral Surgery; A. Conan Davis, DMD, MPH, Chief Dental Officer, Centers for Medicare & Medicaid Services; and Donald A. Schneider, DDS, MPH, Consultant in Health Policy and Dental Health, for their guidance in helping to construct a public dental coverage variable; and Tom

Wall, MA, MBA, Manager Statistical Research, Health Policy Resource Center, American Dental Association; and William R. Maas, DDS, MPH, Director, Division of Oral Health, Centers for Disease Control and Prevention, for their very careful and thoughtful review and suggestions. We wish to also thank the following individuals for their guidance and assistance: Albert H. Guay, Chief Policy Advisor, American Dental Association; Niva Haynes MA, Senior Project Assistant, Legislative & Regulatory Policy, American Dental Association; Janice Kupiec, Manager, Legislative & Regulatory Policy, American Dental Association; and Paul O'Connor, ADA State Legislative Liaison, American Dental Association.

Overview: Medicare/Non-Medicare

Medical Expenditure Panel Survey page iv

Contents

Introduction ......................................................................................................................................................... 1

Source of Data...................................................................................................................................................... 2

Chapter 1. Community Population Section 1: Dental Use .............................................................................................................................................3 Section 2: Dental Coverage ...................................................................................................................................9 Section 3: Changes from 1996 to 2004 ...............................................................................................................15

Chapter 2. Children: Birth–Age 20 Section 1: Dental Use ...........................................................................................................................................35 Section 2: Dental Coverage .................................................................................................................................41 Section 3: Changes from 1996 to 2004 ...............................................................................................................48

Chapter 3. Adults: Age 21–64 Section 1: Dental Use ...........................................................................................................................................69 Section 2: Dental Coverage .................................................................................................................................75 Section 3: Changes from 1996 to 2004 ...............................................................................................................81

Chapter 4: Older Adults: Age 65 and Over Section 1: Dental Use .........................................................................................................................................101 Section 2: Dental Coverage ...............................................................................................................................107 Section 3: Changes from 1996 to 2004 .............................................................................................................113

References ........................................................................................................................................................ 133

Definitions of Terms ........................................................................................................................................ 134

Medical Expenditure Panel Survey page v

Introduction

This chartbook presents data from the 1996 and 2004 Medical Expenditure Panel Survey (MEPS), which is sponsored by the Agency for Healthcare Research and Quality (AHRQ), on dental use and dental coverage for the U.S civilian noninstitutionalized (community) population. The chartbook is organized into four chapters each containing three sections. Chapter 1 presents data for the overall community population, chapter 2 restricts the presentation to children age birth to age 20, chapter 3 restricts the presentation to adults age 21 to age 64, and chapter 4 restricts the presentation to older adults age 65 and older. Each chapter is organized into three sections. Section 1

presents a summary of overall dental use, expenses, procedures, and providers; section 2 contains the prevalence of dental coverage and the relationship of dental coverage to use and expenses; and section 3 contains changes in dental use, dental coverage, and dental procedures from 1996 to 2004. See the Definitions of Terms section for information and definitions of the categories used throughout the chartbook. This chartbook and other MEPS publications are available electronically on the MEPS Web site at http://www.meps.ahrq.gov/.

Medical Expenditure Panel Survey page 1


Source of Data

The estimates shown in this chartbook are drawn from analyses of the following public use files: 1996 Full Year Consolidated Data File HC-012, 2004 Full Year Consolidated Data File HC-089, 1996 Dental Visits File HC-010B, 2004 Dental Visits File HC-085B, and other information available on the MEPS Web site.

Only differences that are statistically significant at the 0.05 level are discussed in the text. In some cases, totals may not add precisely to 100% because of rounding.


Chapter 1 Community Population

Section 1: Dental Use

Medical Expenditure Panel Sur
vey page 3


What proportion of the community has a dental visit?

In 2004, there were about 294 million people in the

community population of the United States.

Approximately 44% of the population had at least one dental visit during the year.

The average expense was $560 per year for persons with a dental visit, and the average number of visits was 2.5 visits per person for persons with a visit (data not shown).

Total population = 294 million

56.4%

43.6% Dental visit

No dental visit



What procedures do people receive?

In 2004, approximately 128 million people with at least one

dental visit received about 572 million dental procedures in the United States.

Approximately 86% of the population with at least one den-

tal visit had at least one diagnostic procedure (examination or x-ray), and about 79% of the population had at least one preventive procedure (cleaning, fluoride, or sealant) during the year.

Together, approximately 73% of all procedures were diagnostic (42.5%) or preventive (30.4%) during 2004.

Distribution of procedures Percentage of population with at least one procedure

Total population with a visit = 128 million

22.2%13.8%

2.3% 4.6%10.9%

6.6% 3.6%

85.8%79.3%

0%

20%

40%

60%

80%

100%

Diagno

stic

Preven

tive

Restor

ative

Prosthe

ticOral

surge

ryPeri

odon

ticEnd

odon

ticOrth

odon

ticOthe

r*

T cedures = 572 million

6.4%

42.5%

4%

6.9%

3.3%

0.9%

6.9%

1.7% 1.0%

DiagnosticPreventiveRestorativeProstheticOral surgeryPeriodonticEndodonticOrthodonticOther*

*Other includes treatment for TMD or TMJ (jaw pain), bonding, whiting, or bleaching. Medical Expenditure Panel Survey page 5

otal pro

30.


What dental providers do people visit?

In 2004, approximately 128 million people in the United

States with at least one dental visit made about 316 million visits to a dental office.

Approximately 82% of all dental visits were to a general

dentist, 2.7% of all visits were to an oral surgeon, and 13.2% of all visits were to an orthodontist.

Approximately 2.4% of dental visits were to other dental providers, including endodontists (dentists who perform root canals) and periodontists (dentists who treat gums).

About 34% of all dental visits included care by both a

dentist and a non-dentist team member.*

Dentist provider visits

Total visits = 316 million

13.2%

81.6%

2.7%

1.5%0.9%

General dentistOral surgeonOrthodontistEndodontistPeriodontist

*Non-dentist team members include dental hygienists, dental technicians, or other non-dentist dental specialists.



How are dental visits distributed across the population?

In 2004, the likelihood of having a dental visit varied by

age, family income, race/ethnicity, and education.

Approximately 45% of children and adolescents (less than age 21) and 39% of young adults (21-44 year olds) had at least one dental visit during the year.

About 49% of adults (45-64 year olds) and 43% of older adults (age 65 and over) had at least one dental visit during the year.

Although 58% of persons from a high income family had at

least one dental visit during the year, only 30% of persons from a family with low income had at least one dental visit during the year.

Percentage with a dental visit

Age Family income

45.4%38.7%

48.6%43.0%

0%

20%

40%

60%

80%

Under 21 21-44 45-64 65 and over

57.9%

41.9%29.9%

26.5%

0%

20%

40%

60%

80%

Poor Low Income Middle Income High Income



Black non-Hispanic and Hispanic persons were less likely

to have a dental visit in 2004 than white non-Hispanic persons or persons of other race/ethnicity categories.

Persons with less than a high school education were less likely to have a dental visit in 2004 than college graduates or children with a college graduate caregiver.


Race/ethnicity Education

30.2% 28.9%

49.4%41.5%

0%

20%

40%

60%

80%

Black non-Hispanic

Hispanic White non-Hispanic

Other *

21.9%

37.3%

54.5%

0%

20%

40%

60%

80%

Some or no school High school graduate College graduate

*Other includes non-Hispanics who reported to be of single race other than white or black (i.e., American Indian/Alaska Native, Asian, or Native Hawaiian/Pacific Islander) as well as non-Hispanics who reported to be of multiple races (possibly including black).



Medical Expenditure Panel Surve

Section 2: Dental Coverage

y page 9


What proportion of the community has dental coverage?

In 2004, approximately 158 million people, or 54% of the community population, had private dental coverage during the year.

Approximately 12% of the community population had public dental coverage only, and 35% of the community population had no dental coverage at all during the year.

11.5%

53.9%

34.6%Private dental coverage

Public coverage only

No dental coverage



How is dental coverage distributed across the population?

In 2004, dental coverage varied by age, family income,

race/ethnicity, and education.

About 61% of middle age adults (45-64 year olds) and 24% of older adults (age 65 and over) had private dental coverage during 2004.

Persons from lower income families were less likely to have private dental coverage in 2004 than persons from a family with higher income.

Children and adolescents (less than age 21), persons who

were poor, and persons from a family with low income were more likely to have public dental coverage in 2004 than adults (age 45 and over) or persons from a family with middle or high income.

Percentage with dental coverage

Age Family income

53.9% 60.1% 60.9%

23.8%

5.7%

6.3%

34.2% 34.3%

69.9%26.2%4.7%

19.9%

0%

20%

40%

60%

80%

100%

Under 21 21-44 45-64 65 and over

14.8%32.6%

58.2%74.4%

20.8%

46.6%36.3%

24.7%

0.8%

43.8%

5.5%

41.4%

0%

20%

40%

60%

80%

100%

Poor Low income Middleincome

High income

Private dental coverage Public dental coverage only No dental coverage



Black non-Hispanic and Hispanic persons were more likely to have public dental coverage and less likely to have private dental coverage in 2004 than white non-Hispanics or persons of other race/ethnicity categories.

Persons with some or no school were more likely to have no dental coverage, more likely to have public dental coverage, and less likely to have private dental coverage in 2004 than high school graduates or college graduates.



55.4%

22.0%

22.6%

6.9% 14.3%

30.3%

58.7%

35.3%48.6%

29.4%42.1%

34.3%

0%

20%

40%

60%

80%

100%

Black non-Hispanic


Other*

25.6%

14.4%

5.3%51.3%

37.6%27.4%

67.2%

48.1%

23.1%

0%

20%

40%

60%

80%

100%

Some or no school High schoolgraduate

College graduate





Do dental care visits vary by dental coverage status?

In 2004, 57% of the population with private dental cover-

age had a dental visit, 32% of the population with public dental coverage only had a dental visit, and 27% of the population without any dental coverage had a dental visit.

Persons with public dental coverage only had fewer visits on average in 2004 than persons with private dental coverage or no dental coverage.

Average number of dental visits for persons with a visit


2.062.39

2.542.47

0

1

2

3

4

Overall Private dentalcoverage

Public dentalcoverage only

No dentalcoverage

31.9%26.9%

56.9%

43.6%

0%

20%

40%

60%

80%



No dentalcoverage



Do dental care expenses vary by dental coverage status?

In 2004, total dental expense for the community population

of the United States was $72 billion.

The average annual expense for a person with a dental visit was $612 for a person with private dental coverage, $326 for a person with public dental coverage only and $482 for a person with no dental coverage during 2004.

Average annual dental expense for a person with a dental visit

$326

$482

$612$560

$0

$200

$400

$600

$800



No dentalcoverage



Medical Expenditure Panel Surve page 15

S 3: Changes from 1996 to 2004

y

ection


How has the percentage of the population with a dental visit changed from 1996 to 2004?

There was no significant change in the percentage of the population with a dental visit from 1996 to 2004.


43.6%42.9%

0%

20%

40%

60%

80%

1996 2004



Children age 21 or less had a statistically significant

increase in the likelihood of having a dental visit from 1996 to 2004.

Adults age 21-44 and individuals from a family with middle income had a statistically significant decrease in the likelihood of having a dental visit from 1996 to 2004.


42.2% 41.2%

48.8%

40.3%45.4%

38.7%

48.6%

43.0%

0%

20%

40%

60%

80%

Under 21 21-44 45-64 65 and over

26.2%28.9%

44.9%

56.6%

26.5%29.9%

41.9%

57.9%

0%

20%

40%

60%

80%

Poor Low income Middle income High income

Age Income

1996 2004



Black non-Hispanics had a statistically significant increase in the likelihood of having a dental visit from 1996 to 2004.



39.3%

23.9%

53.8% 54.5%

21.9%

37.3%

0%

20%

40%

60%

80%

S om e or no schoo l High schoo lgraduate

C ollege graduate

28.5%

41.5%39.3%

26.1%

48.3% 49.4%

30.2% 28.9%

0%

20%

40%

60%

80%

Black non-Hispanic

H ispanic W hite non-H ispanic

O ther*

1996 2004




Persons with public dental coverage only had a statistically

significant increase in the likelihood of having a dental visit from 1996 to 2004.

No significant changes in the likelihood of a dental visit from 1996 to 2004 were found for people with private dental coverage or for persons without dental coverage.


56.0%

28.3% 26.9%28.7%

31.9%

56.9%

0%

20%

40%

60%

80%

Private dentalcoverage


No dental coverage

1996 2004



How have dental visits and dental expenses changed from 1996 to 2004?

The average number of dental visits per person for those with a dental visit decreased from 1996 to 2004.

Average dental expenses increased from $374 ($450 adjusted for inflation) in 1996 to $560 in 2004.


Average dental expense for persons with a dental visit

$560

$374$450

$0

$100

$200

$300

$400

$500

$600

$700

1996 1996 adjusted forInflation

2004

2.55 2.47

0

1

2

3

1996 2004



How have average visits per person for those with a dental visit changed from 1996 to 2004?

The average number of dental visits per person for those with a dental visit decreased for adults age 45-64 and for adults with low or middle income from 1996 to 2004.


Age Income

2.11

2.372.56

2.69

2.19 2.162.36

2.65

0

1

2

3


2.70

2.20

2.702.92

2.64

2.12

2.532.72

0

1

2

3

Under 21 21-44 45-64 65 and over

1996 2004



The average number of dental visits per person for those with a dental visit decreased for college graduates from 1996 to 2004.



2.052.22

2.63 2.54

2.032.17

2.57

2.28

0

1

2

3

Black non-Hispanic


Other*

2.332.44

2.66

2.192.35

2.55

0

1

2

3


College graduate

1996 2004




The average number of dental visits per person for those with a dental visit decreased for persons with private dental coverage

from 1996 to 2004.


2.65

1.97

2.432.54

2.06

2.39

0

1

2

3



No dentalcoverage

1996 2004



How has the average dental expense for those with a dental visit changed from 1996 to 2004?

For each age the average expense (adjusted for inflation) increased from 1996 to 2004.

For each income category except for middle income the average expense (adjusted for inflation) increased from 1996 to 2004.


$512

$425$374

$438

$318

$384

$450

$527

$620$630

$488

$544

$0

$100

$200

$300

$400

$500

$600

$700

$800

Under 21 21-44 45-64 65 and over

$268 $282

$384$415

$323 $340

$462$500

$427 $433

$510

$646

$0

$100

$200

$300

$400

$500

$600

$700

$800


Age Income

1996 1996 adjusted for inflation 2004



White non-Hispanics and Hispanics and persons of other

race/ethnicity categories had a statistically significant increase in expenses from 1996 to 2004.

For each education category, the average expense (adjusted for inflation) increased from 1996 to 2004.



$299 $317

$384$417

$361

$462$502

$430

$599$555

$382$367

$0

$200

$400

$600

$800

B lack N on-H ispanic

H ispanic W hite N on-H ispan ic

O ther*

$330$370

$402$435 $449

$495$524 $540

$596

$0

$200

$400

$600

$800


College graduate





For each dental coverage category the average expense (adjusted for inflation) increased from 1996 to 2004.

Average dental expense for those with a dental visit

$415

$204

$304

$500

$245

$366

$612

$326

$482

$0

$200

$400

$600

$800



No dental coverage




How has the likelihood of having at least one type of procedure changed from 1996 to 2004?

People were more likely to have at least one diagnostic or preventive procedure and less likely to have one restorative, prosthetic, surgical, or other procedure in 2004 than in 1996.

2 4 .2 %

1 5 .2 %

2 .6 %5

8 5 .8 %

7 9 .3 %

2 2 .2 %

1 3 .8 %1 0 .9 %

2 .3 %%

6 .6 %3 .6 %

1 2 .5 %

5 .9 % 4 .5 %

8 2 .7 %

7 4 .6 %

0 %

2 0 %

4 0 %

6 0 %

8 0 %

1 0 0 %

D ia g n o s tic P re ve n tive R e s to ra tive P ro s th e tic O ra l s u rg e ry P e r io d o n tic E tic O rth o d o n tic O th e r*

Percentage of the population with at least one procedure

1996 2004

*Other includes treatment for TMD or TMJ (jaw pain), bonding, whiting, or bleaching.


.1 % 4 .6

n d o d o n


How has the distribution of procedures changed from 1996 to 2004?

The total number of procedures increased from about 496 million in 1996 to about 572 million in 2004 (data not shown).

As a percentage of all procedures, diagnostic and preventive procedures increased while restorative, prosthetic, surgical, endodontic, and other procedures decreased from 1996 to 2004.

8 .2 %

4 .1 %

0 .9 %

4 0 .2 %

1 .5 %

6 .8 %

%

7 .3 %

2 9 .0 %

0

3 .3 %

6 .4 %6 .9 %

3 0 .4 %

1 .7 %

4 2 .5 %

1 .0 %

6 .9 %

0 %

1 0 %

2 0 %

3 0 %

4 0 %

5 0 %

D ia g n o s t ic P r e v e n t iv e R e s to r a t iv e P r o s th e t ic O r a l s u r g e r y P e r id o n t i o d o n t ic O r th o d o n t ic O th e r *

Distribution of dental procedures

1996 2004



2 .1.9 %

c E n d


How have dental expenses changed from 1996 to 2004 by category of procedure?

¢� Average dental expenses increased from $115 ($139 adjusted for inflation) in 1996 to $172 and from $136 ($164 adjusted for inflation) in 1996 to $217 for preventive/ diagnostic procedures and restorative procedures, respectively, in 2004.

¢� Expenses for other dental procedures (periodontic, orthodontic, prosthetic, endodontic, and oral surgery) increased from $213 ($257 adjusted for inflation) in 1996 to $354 in 2004.

$800 Average dental expense per visit by procedure category

$600

$400 $354

$257 $228

$217 $213 $177 $172 $164 $200 $147 $139 $136

$115

$0 Overall Preventive/Diagnostic Restorative Other*

j i l i1996 1996 ad usted for nf at on 2004

*Other includes periodontic (gums), orthodontic (braces), prosthetic (crown, bridges, and dentures), endodontic (root canals), oral surgery, treatment for TMD or TMJ (jaw pain), and bonding, whiting, or bleaching.



How has the percentage of people with dental coverage changedfrom 1996 to 2004?

¢� The percentage of people with public dental coverage only ¢ No change was observed in private dental coverage. increased from 1996 to 2004.

¢� The percentage of people without any dental coverage decreased from 1996 to 2004.


80%

60% 53 .9% 52 .2%

38 .4% 40% 34 .6%

20%11 .5%9 .4%

0% P riva te den ta l coverage P ub lic den ta l coverage on ly N o den ta l coverage

1996 2004



How has distribution of dental coverage changed from 1996 to 2004?

Children were more likely to have public dental coverage only and less likely to have no dental coverage in 2004 than in 1996.

Adults age 45-64 were less likely to have no dental coverage in 2004 than in 1996.

Ad u lts ag e 21-44

5 7 .9 %

5 .8 %

3 6 .3 %

60.1%

5.7%

34.2%

0%

20%

40%

60%

80%

Priva te denta l coverage Pub lic denta l coverage only No denta l coverage

Changes in

coverage by age

Ad u lts ag e 45-64

5 8 .7 %

3 .9 %

3 7 .4 %

60.9%

4.7%

34.3%

0%

20%

40%

60%

80%


O ld er ad u lts ag e 65 an d ab o v e

23.2%

7.9%

68.9%

23.8%

6.3%

69.9%

0%

20%

40%

60%

80%


C h ild ren ag e b irth -20

53.2%

18.0%

28.8%

53.9%

26.2%19.9%

0%

20%

40%

60%

80%


1996 2004



Persons from

have public dental dental coverage in 2004 than in 1996.

e more likely to have no

age in 2004 than in 1996.

a family with low income were more likely to coverage only and less lik

Persons from a family with high income werate dental coverage and less likelyely to have no to have priv

dental cover

Persons from a family with middle income were more likely to have public dental coverage only in 2004 than in 1996.

Changes in coverage by income

Po o r

16.0%

41.5% 42.5%

14.8%

43.8% 41.4%

0%Priva te denta l coverage Pub lic denta l coverage only No denta l coverage

20%

40%

60%

80% Low fam ily incom e

34.3%

11.8%

53.8%

32.6%

20.8%

46.6%

0%

20%

40%

60%

80%


M iddle fam ily incom e

60.8%

2.5%

36.7%

58.2%

5.5%

36.3%

0%

20%

40%

60%

80%


H ig h fa m ily in c o m e70 .0%

1 .0%

29.0%

74 .4%

0.8%

24.7%

0%P riva te denta l coverage P ub lic denta l cove rage only No denta l coverage

20%

40%

60%

80%

1996 2004



¢ Black non-Hispanics were less likely to have no dental ¢ White non-Hispanics were more likely to have private or coverage in 2004 than in 1996. public dental coverage and less likely to have no dental

coverage from 1996 to 2004.

Changes in coverage by race/ethnicity

80% H isp an ic 80% Bla c k n o n -H isp a n ic

60% 60%

48.6% 43.4% 42.1% 43.8%

40%40% 36.5% 34.7% 35.3%

29.4%

21.9% 22.6% 22 .0%

19.7% 20% 20%

0% 0% Pr ivate denta l coverage Public denta l coverage only No denta l coverage P rivate d ental cove rage P ub lic d ental co ve rag e only No d ental co ve rage

W h ite n o n-H isp an ic 80% O th er* 80%

5 6.3%

5 .4 %

3 8.3%

58 .7 %

6.9%

34 .3 %

60% 55.4% 60% 53.4%

40% 40%32.1% 30.3%

20% 20% 14.5% 14.3%

0% Private dental coverag e Pub lic de ntal coverag e only No dental coverage Private denta l coverage Public denta l coverage only No dental coverage

0%

1996 2004




For each education category, people were more likely tocoverage in 2004 than in 1996.

have l

pub ic dental coverage only and less likely to have no dental

Changes in coverage by education

So m e o r n o sch o o l80% High school graduate80%

22.5% 22.4%

55.1%

23.1%25.6%

51.3%

0%

20%

40%

60%

Priva te denta l coverage Public denta l coverage only No denta l coverage

49.7%

10.2%

40.0%

48.1%

14.4%

37.6%

0%

20%

40%

60%

P rivate dental cove rage Pub lic dental cove rage only No dental cove rage

C o lleg e g rad u ate80%

66.8%

3.4%

29.9%

67.2%

5.3%

27.4%

0%

20%

40%

60%


1996 2004


Chapter 2 Children: Birth–Age 20


vey page 35

Children: Birth–Age 20

What proportion of children has a dental visit?

In 2004, there were about 86 million children in the United

States.

Approximately 45% of children had at least one dental visit during the year.

The average expense was $544 per year for children with a dental visit, and the average number of visits was 2.6 visits per child for children with a visit (data not shown).

Total child population = 86 million

45.4%

54.6%Dental visit

No dental visit



What procedures do children receive?

In 2004, approximately 39 million children with at least

one dental visit received about 186 million dental procedures in the United States.

Approximately, 88% of children receiving at least one den-

tal visit had at least one diagnostic procedure (examination or x-ray), and about 82% of children had at least one pre-ventive procedure (cleaning, fluoride, or sealant) during the year.

Together, approximately 72% of all procedures were diagnostic (39.1%) or preventive (33.1%) during 2004.

Percentage of children with at least one procedure ribution of procedures

rocedures = 186 million

0.9%

1.0%

18.0%

2.2%

33.1%

39.1%

DiagnosticPreventiveRestorativeProstheticOral surgeryOrthodonticOther*


20.4%

2.4%

17.6%

3.5%8.5%

88.0%82.0%

0%

20%

40%

60%

80%

100%

Diagnos

ticPrev

entiv

eResto

rative

Prostheti

cOral s

urgery

Orthodo

ntic

Other*

*Other includes periodontics (gums), endodontics (root canals), treatment for TMD or TMJ (jaw pain nding, whiting, or bleaching.


Dist

Total p

5.7%

), and bo


What dental providers do children visit?

In 2004, children made about 103 million visits to a dental

office in the United States.

Approximately 63% of all children’s dental visits were to a General Dentist. While 2% of children’s dental visits were to an oral surgeon, 35% were to an orthodontist.

Less than 1% of all children’s dental visits were to other dental providers, including endodontists (dentists who perform root canals) and periodontists (dentists who treat gums).





62.9%

2.0%

34.6%

0.5%

General dentist

Oral surgeon

Orthodontist

Endodontist orPeriodontist




How are dental visits distributed across the population?

In 2004, the likelihood of a child having a dental visit

varied by age, family income, race/ethnicity, and education.

Approximately 48% of the adolescents age 13-20 and 59% of children age 6-12 had at least one dental visit during the year.

While 62% of children from a high-income family had at least one dental visit during the year, 34% of children from a family with low income had at least one dental visit during the year.

Percentage of children with a dental visit

Age Family income

47.9%

59.2%

25.1%

0%

20%

40%

60%

80%

Under 6 6 - 12 13 - 20

46.5%

61.8%

33.9%30.8%

0%

20%

40%

60%

80%

Poor Low income Middle inicome High income



Black non-Hispanic and Hispanic children were less likely

to have a dental visit in 2004 than white non-Hispanic children or children of other race/ethnicity categories.

Children with a caregiver with less than high school education were less likely to have a dental visit in 2004 than children with a high school graduate or college graduate caregive


aregiver education Race/ethnicity

54.4%

37.9%

25.2%

0%

20%

40%

60%

80%

Some or no scho High schoolgraduate

College graduate

52.5%43.7%

32.9%34.1%

0%

20%

40%

60%

80%

Black non-Hispanic


Other *

*Other includes non-Hispanics who reported to be of single race other than white or black (i.e., American dian/Alaska Native, Asian, or Native Hawaiian/Pacific Islander) as well as non-Hispanics who reported to be of multiple races (possibly includ black).


r.

C

ol

Ining




y page 41


What proportion of children has dental coverage?

In 2004, approximately 46 million children or 54% of children had private dental coverage during the year.

Approximately 26% of all children had public dental coverage only, and slightly less than 20% of all children had no dental coverage.

26.2%

53.9%

19.9% Private dental coverage


No dental coverage



How is dental coverage distributed across the population?



Children from a family with lower income were less likely to have private dental coverage and more likely to have public dental coverage only in 2004 than children from a family with higher income.

Children from a family with low or middle income were more likely to have no dental coverage compared with poor children or children from a family with high income.


Age Family income

33.1%27.0%

20.7%

17.8% 17.1%23.6%

55.7%55.9%49.1%

0%

20%

40%

60%

80%

100%

Under 6 6 - 12 13 - 20

80.3%

73.4%40.9%

11.8%

17.8%

65.6%

34.3%

13.9%

1.9%

12.7%24.8% 22.5%

0%

20%

40%

60%

80%

100%

Poor Low income Middleincome

High income




Black non-Hispanic and Hispanic children were more likely to have public dental coverage and less likely to have private dental coverage in 2004 than white non-Hispanics or children of other race/ethnicity categories.

Children with a caregiver with some or no school were more likely to have public dental coverage and less likely to have private dental coverage in 2004 than children with high school gradu or college graduate caregivers.


Race/ethnicity Caregiver education

55.3%

44.9%

42.9%

16.2%25.4%

19.3%

63.5%

31.8%43.5%

11.6%25.3%

20.3%

0%

20%

40%

60%

80%

100%

Black non-Hispanic


Other*

60.

37.3%

12.1%

23. 20.2% 18.9%

69.0%

42.4%

16.8

0%

20%

40%

60%

80%

100%

Some nosch l

High schoolgraduate

College graduate

Private dental coverage Public dental coverage only N ental coverage

*Other includes non-Hispanics who reported to be of single race other than white or black (i.e., American ian/Alaska Native, Asian, or Native Hawaiian/Pacific Islander) as well as non-Hispanics who reported to be of multiple races (possibly includ black).


ate

0%

2%

%

or oo

o d

Inding



In 2004, while 58% of children with private dental coverage had a dental visit, 34% of children with public dental coverage only

had a dental visit, and 28% of children without any dental coverage had a dental visit.

Percentage with a dental visit Average number of dental visits for children with a visit

1.88

2.712.85

2.64

0

1

2

3

4



No dentalcoverage

34.1%27.5%

57.5%

45.4%

0%

20%

40%

60%

80%



No dentalcoverage




In 2004, the total dental expense for children in the United

States was $21 billion.

The average annual expense for children with a visit was $635 for children with private dental coverage and $272 for children with public dental coverage only during 2004.

Average annual dental expense for children with a dental visit during 2004

$272

$470

$635

$544

$0

$200

$400

$600

$800



No dentalcoverage



The average annual orthodontic expense was $1,375, and the average annual non-orthodontic expense was $318 for children

during 2004.

Average annual orthodontic dental expense for children with an orthodontic visit during 2004

Average annual non-orthodontic dental expense for children with an orthodontic visit during 2004

$1,233

$1,045

$1,449$1,375

$0

$400

$800

$1,200

$1,600



No dentalcoverage

$203$275

$358$318

$0

$400

$800

$1,200

$1,600



No dentalcoverage



Medical Expenditure Panel Surve page 48

S 3: Changes from 1996 to 2004

y

ection


How has the percentage of children with a dental visit changed from 1996 to 2004?

Children were more likely to have a dental visit in 2004 compared with 1996, which corresponds with the enactment of SCHIP (State Children’s Health Insurance Program) and public dental coverage only extensions among children.


42.2%45.4%

0%

20%

40%

60%

80%

1996 2004



Children under age 6, children age 6-12, and low-income children experienced an increase in the likelihood of a dental visit

between 1996 and 2004.


Age Income

21.1%

54.4%

47.6%

25.1%

59.2%

47.9%

0%

20%

40%

60%

80%

Under 6 6 - 12 13 - 20

27.6% 27.4%

49.4%

58.9%

30.8%33.9%

46.5%

61.8%

0%

20%

40%

60%

80%


1996 2004



Black non-Hispanic and Hispanic children had a statistically significant increase in the likelihood of having a dental visit from

1996 to 2004.



37.7%

24.5%

50.9%54.4%

2 2%

37.9%

0%

20%

40%

60%

80%

Som e or no hoo l H igh schoolgraduate

College graduate

28.6%

43.7%39.8%

25.5%

49.5%52.5%

34.1% 32.9%

0%

20%

40%

60%

80%

Black non-H ispanic


O ther*

1996 2004



5.

sc

Inding


Children with public dental coverage only had an increase

in the likelihood of having a dental visit from 1996 to 2004. No significant change in the likelihood of having a dental

visit from 1996 to 2004 was found for children with private dental coverage or for children without dental coverage.


55.2%

28.4% 27.5%26.9%

34.1%

57.5%

0%

20%

40%

60%

80%

Private dental coverage

Public dental coverage only

No dental coverage

1996 2004




There was no statistically significant change in the average number of dental visits per child for those with a dental visit from 1996 to 2004.


Average number of dental visits for children with a visit

Average dental expense for children with a dental visit

2.70 2.64

0

1

2

3

1996 2004

$544$450

$374

$0

$200

$400

$600

$800

1996 1996 adjusted forinflation

2004



The average dental orthodontic expense increased from

$930 ($1,120 adjusted for inflation) in 1996 to $1,375 in 2004.

The average dental non-orthodontic expense increased from $229 ($275 adjusted for inflation) in 1996 to $318 in 2004.

Average orthodontic dental expense for children with a dental visit

Average non-orthodontic dental expense for children with a dental visit

$318$275$229

$0

$400

$800

$1,200

$1,600


2004

$1,375

$1,120

$930

$0

$400

$800

$1,200

$1,600


2004



How have average visits per child for those with a dental visit changed from 1996 to 2004?

There were no statistically significant changes in the average number of visits for children with a dental visit by age or income from 1996 to 2004.


Age Income

1.54

2.47

3.33

1.60

2.40

3.26

0

1

2

3

4

Under 6 6 - 12 13 - 20

2.012.21

2.73

3.15

1.842.04

2.58

3.19

0

1

2

3

4


1996 2004



There were no statistically significant changes in the average number of visits by children with a dental visit by race/ethnicity or

caregiver education from 1996 to 2004.

Average number of dental visits for children with a vis


1.77

2.21

2.853.12

1.92

2.28

2.86

2.31

0

1

2

3

4

Black non-Hispanic


Other*

2.28 2.27

2.97

1

2.33

2.84

0

1

2

3

4

Some orschoo

High schoolgraduate

College graduate

1996 2004

*Other includes non-Hispanics who reported to be of single race other than white or black (i.e., American dian/Alaska Native, Asian, or Native Hawaiian/Pacific Islander) as well as non-Hispanics who reported to be of multiple races (possibly includ black).


it

.91

nol

Ining


There were no significant changes by dental coverage status in the average number of visits for children with a dental visit from

1996 to 2004.


2.88

1.75

2.612.85

1.88

2.71

0

1

2

3



No dentalcoverage

1996 2004



How has the average dental expense for children with a dental visit changed from 1996 to 2004?

The average expense (adjusted for inflation) for children under age 6 and children age 6-12 increased from 1996 to 2004.


Age Income

$612

$508

$124

$327

$393

$149

$728

$490

$186

$0

$100

$200

$300

$400

$500

$600

$700

$800

Under 6 6 - 12 13 - 20

$481

$399

$226

$470

$220$264$272

$566

$713

$536

$350

$277

$0

$100

$200

$300

$400

$500

$600

$700

$800

Poor Low familyincome

Middle familyincome

High familyincome




White non-Hispanic children and children with a college graduate caregiver had a statistically significant increase in average

dental expenses (adjusted for inflation) from 1996 to 2004.

Average dental expense for children with a dental v it


$480

$399

$245

$420

$281$338

$295

$506 $485

$628

$367

$282

$0

$100

$200

$300

$400

$500

$600

$700

$800

Black non-Hispanic


Other*

$493

$410

$223

$345

$415

$269

$610

$420

$34

$0

$100

$200

$300

$400

$500

$600

$700

$800

Less than higschool

High schoolgraduate

College graduate




is

8

h

Inding


For children with private or public dental coverage only the

average dental expense (adjusted for inflation) increased from 1996 to 2004.

No significant change (adjusted for inflation) was observed for children without dental coverage from 1996 to 2004.


$433

$151

$295

$521

$182

$355

$635

$272

$470

$0

$200

$400

$600

$800



No dental coverage





Children were more likely to have at least one preventive procedure and less likely to have one oral surgery procedure in 2004 than in 1996.

Percentage of population with at least one procedure

1 9 .8 %

2 .9 %

1 6 .7 %

4 .4 %

8 8 .0 %

8 2 .0 %

2 0 .4 %

2 .4 %

8 .5 %

1 7 .6 %

3 .5 %

1 0 .4 %

8 5 .9 %

7 6 .3 %

0 %

2 0 %

4 0 %

6 0 %

8 0 %

1 0 0 %

n o s tic P re v e n tiv e R e s to ra t iv e P ro s th e t ic O ra l S u rg e ry O r th o d o n tic O th e r *

1996 2004

*Other includes p

Medical Expendi

D ia g

eriodontics (gums), endodoontics (root canals), treatment for TMD or TMJ (jaw pain), and bonding, whiting, or bleaching.

ture Panel Survey page 61




As a percentage of all procedures, from 1996 to 2004 preventive procedures increased while oral surgery and other procedure types decreased.


6 .4 %

3 .0 %

1 8 .9 %

3 8 .6 %

1 .4 %1 .0 %

3 0 .7 %

1 8 .0 %

2 .2 %0 .9 %

5 .7 %

3 3 .1 %

1 .0 %

3 9 .1 %

0 %

1 0 %

2 0 %

3 0 %

4 0 %

5 0 %

D ia g n o s t ic P r e v e n t iv e R e s to r a t iv e P r o s th e t ic O r a l S u r g e r y O r th o d o n t ic O th e r *

1996 2004

*Other includes periodontics (gums), endodoontics (root canals), treatment for TMD or TMJ (jaw pain), and bonding, whiting, or bleaching.




Average dental expenses increased from $108 ($130 adjusted for inflation) in 1996 to $163 and $129 ($155 adjusted for inflation) in 1996 to $216 for diagnostic/preventive procedures and restorative procedures, respectively, in 2004.

Average dental expense for children per visit by procedure category

$188$167

$227

$163

$275

$129$138$108

$130$155

$216$206

$0

$200

$400

$600

$800

Overall Preventive/D iagnos tic Res torative Other*





How has the percentage of children with dental coverage changed from 1996 to 2004?

The percentage of children with public dental coverage

only increased from 1996 to 2004. The percentage of children with no dental coverage

decreased from 1996 to 2004.

Percentage of children with dental coverage

53.2%

18.0%

28.8%

53.9%

26.2%

19.9%

0%

20%

40%

60%

80%

P riva te den ta l coverage P ub lic denta l coverage on ly N o den ta l coverage

1996 2004




While no significant changes by age in the percentage of children with private dental coverage from 1996 to 2004 were noted, children of all ages were much more likely to have public dental coverage only and less likely to have no dental coverage in 2004 than in 1996.

Changes in coverage by age C h ild ren ag e 6 -12

55.1%

17.9%

27.0%

55.9%

27.0%

17.1%

0%

20%

40%

60%

80%

P rivate d e ntal c o ve rag e P ub lic d e ntal c o ve rag e o nly No d e ntal c o ve rag e

C h ild ren ag e b irth -5

48.8%

25.7% 25.4%

49.1%

33.1%

17.8%

0%

20%

40%

60%

80%


C h ild ren ag e 13-20

55.0%

12.0%

33.1%

55.7%

20.7%23.6%

0%

20%

40%

60%

80%


1996 2004



Poor, low-income, and middle-income children were much

more likely to have public dental coverage only and less likely to have no dental coverage in 2004 than in 1996.

Low-income and middle-income children were less likely

to have private dental coverage in 2004 than in 1996.

High-income children were more likely to have private dental coverage and less likely to have no dental coverage in 1996 than in 2004.


P o o r

15 .7%

59.8%

24.5%

13.9%

73.4%

12 .7%

0%

20%

40%

60%

80%

100%

P riva te denta l coverage P ub lic den ta l coverage on ly N o denta l cove rage

Low fam ily incom e

41.3%

18.0%

40.7%34.3%

40.9%

24.8%

0%

20%

40%

60%

80%

100%


H ig h fa m ily in c o m e

7 3 .4 %

1 .8 %

2 4 .8 %

8 0 .3 %

1 .9 %

1 7 .8 %

0 %

2 0 %

4 0 %

6 0 %

8 0 %

1 0 0 %

P riva te d e n ta l c o ve ra g e P u b lic d e n ta l c o ve ra g e o n ly N o d e n ta l c o ve ra g e

Middle family income

70.2%

3.4%

26.4%

65.6%

11.8%

22.5%

0%

20%

40%

60%

80%

100%


1996 2004



Black non-Hispanic, white non-Hispanic, and Hispanic

children were much more likely to have public dental coverage only and less likely to have no dental coverage in 2004 than in 1996.

Children of other race/ethnicity categories were less likely to have no dental coverage in 2004 than in 1996.


Black n o n -H isp an ic

3 9 .5 %3 3 .7 %

2 6 .8 %

43.5% 44.9%

11.6%

0%

20%

40%

60%

80%

100%


Hispanic

31.2%35.0% 33.9%31.8%

42.9%

25.3%

0%

20%

40%

60%

80%

100%


White non-Hispanic

61.5%

10.1%

28.4%

63.5%

16.2%20.3%

0%

20%

40%

60%

80%

100%


Other*

53.1%

22.3% 24.5%

55.3%

25.4%19.3%

0%

20%

40%

60%

80%

100%


1996 2004




Children with a high school graduate caregiver had a statistically significant decrease in the likelihood of having private dental coverage from 1996 to 2004.

Children of caregivers of all levels of education were much more likely to have public dental coverage only and less likely to have no dental coverage in 2004 than in 1996.

Changes in coverage by caregiver education

H ig h sch o o l g rad u ate

4 7 .9 %

2 1 .8 %

3 0 .3 %

42.4%37.3%

20.2%

0%

20%

40%

60%

80%

100%


So m e o r n o sch o o l

1 7 .6 %

4 8 .1 %

3 4 .2 %

16.8%

60.0%

23.2%

0%

20%

40%

60%

80%

100%


C o lleg e g rad u ate

6 7 .7 %

6 .3 %

2 6 .0 %

69.0%

12.1%18.9%

0%

20%

40%

60%

80%

100%


1996 2004


Chapter 3 Adults: Age 21–64


vey page 69

Adults: Age 21–64

What proportion of adults has a dental visit?

In 2004, there were about 171 million adults (age 21-64) in

the community population of the United States.

Approximately 43% of the adult population had at least one dental visit during the year.

The average expense was $556 per year for adults with a dental visit, and the average number of visits was 2.3 visits per adult for adults with a visit (data not shown).

Total adult population = 171 million

42.9%

57.1%

Dental visit

No dental visit


Adults: Age 21–64

What procedures do adults receive?

In 2004, approximately 73 million adults with at least one

dental visit received about 312 million dental procedures in the United States.

Approximately 86% of the adult population with at least

one dental visit had at least one diagnostic procedure (examination or x-ray), and about 79% of the adult population had at least one preventive procedure (cleaning, fluoride, or sealant) during the year.

Together, approximately 74% of all adult procedures were diagnostic (44.6%) or preventive (29.5%) during 2004.

Percentage of population with at least one procedure Distribution of procedures

procedures = 312 million

7.8%

44.6%

9.5%

1.8%3.8%

1.2%

7

2.5%1.3%

DiagnosticPreventiveRestorativeProstheticOral surgeryPeriodonticEndodonticOrthodonticOther*


22.6%16.4%

3.2% 6.2%11.5%

2.1%4.4%

85.5%78.9%

0%

20%

40%

60%

80%

100%

Diagno

stic

Preven

tive

Restor

ative

Prosthe

ticOral

surge

ryPeri

odon

ticEnd

odon

ticOrth

odon

ticOthe

r*

*Other includes treatment for TMD or TMJ (jaw pain), and bonding, whiting, or bleaching.


Total

2

.5%

Adults: Age 21–64

What dental providers do adults visit?

In 2004, approximately 73 million adults with at least one

dental visit made about 170 million visits to a dental office in the United States.

Approximately 91% of adult dental visits were to a general

dentist. While 2.9% of adult dental visits were to an oral surgeon, 3.4% were to an orthodontist.

Approximately 3.2% of adult dental visits were to other dental providers including endodontists (dentists who perform root canals) and periodontists (dentists who treat gums).





90.5%

2.1%3.4%

2.9%

1.1%

General dentistOral surgeonOrthodontistPeriodontistEndodontist



Adults: Age 21–64

How are dental visits distributed across the adult population?

In 2004, the likelihood of having a dental visit varied by

age, family income, race/ethnicity, and education.

Approximately 39% of adults age 21-44 had at least one dental visit during the year, and 49% of adults age 45-64 had at least one dental visit during the year.

While 56% of adults from a high-income family had at least one dental visit during the year, only 27% of adults from a family with low income had at least one dental visit during the year.


Age Family income

56.2%

39.7%26.9%

22.7%

0%

20%

40%

60%

80%


38.7%

48.6%

0%

20%

40%

60%

80%

21-44 45-64


Adults: Age 21–64

Black non-Hispanics and Hispanics were less likely to have

a dental visit in 2004 than white non-Hispanic adults or adults of other race/ethnicity categories.

Adults with less than a high school education were less likely to have a dental visit in 2004 than college graduates.


Education Race/ethnicity

20.8%

35.7%

53.6%

0%

20%

40%

60%

80%


College graduate

29.6% 26.8%

48.7%40.8%

0%

20%

40%

60%

80%

Black non-Hispanic


Other *



Adults: Age 21–64



y page 75

Adults: Age 21–64

What proportion of adults has dental coverage?

In 2004, approximately 103 million adults or 60% of the adult community population had private dental coverage during the year.

34.3%

60.4%

5.3%



No dental coverage


Adults: Age 21–64

How is dental coverage distributed across the adult population?



Adults from a family with lower income were less likely to have private dental coverage and more likely to have public coverage.

Poor adults and adults from a family with low income were more likely to have no dental coverage in 2004 than adults from a family with middle or high income.


Age Family income

60.9%60.1%

4.7%5.7%

34.2% 34.3%

0%

20%

40%

60%

80%

100%

21-44 45-64

78.3%

24.5%

10.7%

21.4%

62.5%

38.1%

16.4%

0.3%

2.8%

59.1%51.2%

34.8%

0%

20%

40%

60%

80%

100%




Adults: Age 21–64

Black non-Hispanics and Hispanics were more likely to have no dental coverage in 2004 than white non-Hispanic adults or adults of other race/ethnicity categories.

Adults with less than a high school education were more likely to have no dental coverage in 2004 than high school or college graduates.



61.9%

9.2%

8.9%

3.8% 6.2%

31.9%

65.3%

39.7%55.9%

35.0%

51.5%

30.9%

0%

20%

40%

60%

80%

100%

Black non-Hispanic


Other*

13.8%

6.6%

55.6%

36.9%26.5%

71.4%

56.5%

30.6%

2.1%

0%

20%

40%

60%

80%

100%


College graduate




Adults: Age 21–64


In 2004, 56% of the adult population with private dental coverage had a dental visit, 28% of the adult population with public

dental coverage only had a dental visit, and 22% of adults without any dental coverage had a dental visit.



2.392.12

2.362.32

0

1

2

3

4



No dentalcoverage

27.9%22.2%

55.9%

42.9%

0%

20%

40%

60%

80%



No dentalcoverage


Adults: Age 21–64


In 2004, total dental expenses for the adult community population of the United States was $41 billion (data not shown).

Average annual dental expense for persons with a dental visit during 2004

$442 $466

$582$556

$0

$200

$400

$600

$800



No dentalcoverage


Adults: Age 21–64

Se 3: Changes from 1996 to 2004


ction

Adults: Age 21–64

How has the percentage of the adult population with a dental visit changed from 1996 to 2004?

There was no significant change in the percentage of adults with a dental visit from 1996 to 2004.


43.9% 42.9%

0%

20%

40%

60%

80%

1996 2004


Adults: Age 21–64

Younger and middle-income adults had a significant decrease in the likelihood of having a dental visit from 1996 to 2004.


Age Income

41.2%

48.8%

38.7%

48.6%

0%

20%

40%

60%

80%

21-44 45-64

25.4%30.1%

42.8%

55.7%

22.7%26.9%

39.7%

56.2%

0%

20%

40%

60%

80%


1996 2004


Adults: Age 21–64

High school graduates had a significant decrease in the likelihood of having a dental visit from 1996 to 2004.



38.9%

23.7%

54.6% 53.6%

20.8%

35.7%

0%

20%

40%

60%

80%

Som e or no schoo l H igh schoolgraduate

College graduate

28.8%

40.8%40.1%

27.8%

48.9% 48.7%

29.6% 26.8%

0%

20%

40%

60%

80%

Black non-H ispanic


O ther*

1996 2004



Adults: Age 21–64

Adults without dental coverage had a statistically significant decrease in the likelihood of having a dental visit from 1996 to 2004.


55.7%

32.5%

22.2%26.8%27.9%

55.9%

0%

20%

40%

60%

80%



No dental coverage

1996 2004


Adults: Age 21–64


There was no statistically significant change in the average number of dental visits per adult for those with a dental visit from 1996 to 2004.


Average number of dental visits for adults with a visit

Average dental expense for adults with a dental visit

2.40 2.32

0

1

2

3

1996 2004

$556

$361$434

$0

$200

$400

$600

$800


2004


Adults: Age 21–64

How have average visits per adult for those with a dental visit changed from 1996 to 2004?

Adults age 45-64 and adults in the low- or middle-income category had a significant decrease in the number of dental visits per year from 1996 to 2004.


Age Income

2.20

2.70

2.12

2.53

0

1

2

3

4

21-44 45-64

2.102.38 2.33

2.492.38

2.08 2.182.42

0

1

2

3

4


1996 2004


Adults: Age 21–64

There was no statistically significant change in the average number of dental visits per adult for those with a dental visit from 1996

to 2004, when considered by race/ethnicity or by educational attainment.



2.14 2.172.45

2.232.08 2.06

2.382.25

0

1

2

3

4

Black non-Hispanic


Other*

2.212.40 2.43

2.26 2.28 2.34

0

1

2

3

4

Some or noschool

High schoolgraduate

College graduate

1996 2004



Adults: Age 21–64

Adults with private dental coverage had a significant decrease in the number of dental visits per year from 1996 to 2004.


2.472.24 2.19

2.36 2.392.12

0

1

2

3



No dentalcoverage

1996 2004


Adults: Age 21–64


For each age and income category, the average expense (adjusted for inflation) increased from 1996 to 2004.


Age Income

$319

$425

$512

$384

$630

$488

$0

$100

$200

$300

$400

$500

$600

$700

$800

21-44 45-64

$416

$345$293

$392

$302

$364$352

$472

$613

$485$481$496

$0

$100

$200

$300

$400

$500

$600

$700

$800




Adults: Age 21–64

While black non-Hispanic and Hispanic adults and adults

of other race/ethnicity categories did not have a statistically significant increase in expenses (adjusted for inflation) from 1996 to 2004, white non-Hispanic adults did.

For each education category, the average expense (adjusted for inflation) increased from 1996 to 2004.



$438

$364$313

$413

$313

$377$377

$497

$594$577

$466$424

$0

$100

$200

$300

$400

$500

$600

$700

$800

Black non-Hispanic


Other*

$450

$374

$300$355

$427

$361

$548$571$584

$0

$100

$200

$300

$400

$500

$600

$700

$800

Less than highschool

High schoolgraduate

College graduate




Adults: Age 21–64

For adults with private or no dental coverage, the average

expense (adjusted for inflation) increased from 1996 to 2004.

No significant change (adjusted for inflation) was observed for adults with public dental coverage only from 1996 to 2004.


$393

$254 $273

$473

$306 $329

$582

$442 $466

$0

$200

$400

$600

$800



No dental coverage


Medical Expend
iture Panel Survey page 92

Adults: Age 21–64


Adults were more likely to have at least one diagnostic, preventive, or orthodontic procedure and less likely to have at least one restorative or oral surgery procedure in 2004 than in 1996.

Percentage of population with at least one procedure

2 5 .3 %

1 7 .9 %

3 .2 %6 .5 %

8 5 .5 %

7 8 .9 %

1 6 .4 %

1 1 .5 %

3 .2 %6 .2 %

2 .1 %4 .4 %

1 3 .2 %

1 .4 %

5 .1 %

8 1 .8 %

7 4 .3 %

2 2 .6 %

0 %

2 0 %

4 0 %

6 0 %

8 0 %

1 0 0 %

o s tic P re v e n t iv e R e s to ra tiv e P ro s th e tic O ra l s u rg e ry P e r io d o n tic E n d o d o n t ic O rth o d o n tic O th e r*

*Other includes

Medical Expend

D ia g n

1996 2004

treatment for TMD or TMJ (jaw pain), bonding, whiting, or bleaching.

iture Panel Survey page 93

Adults: Age 21–64



As a percentage of all procedures, from 1996 to 2004 diagnostic procedures increased while restorative, pros-thetic, oral surgery, and other procedure types decreased.

8 .9 %

4 .6 %

1 .2 %

4 1 .6 %

1 .8 %1 .6 %2 .9 %

8 .8 %

2 8 .7 %

1 .2 %

3 .8 %

7 .8 %7 .5 %

2 9 .5 %

2 .5 %

4 4 .6 %

1 .3 %1 .8 %

0 %

1 0 %

2 0 %

3 0 %

4 0 %

5 0 %

D ia g n o s t ic P r e v e n t iv e R e s to r a t iv e P r o s th e t ic O r a ls u r g e r y

P e r io d o n t ic E n d o d o n t ic O r th o d o n t ic O th e r *


1996 2004



Adults: Age 21–64


Average dental expenses increased from $115 ($138 adjusted for inflation) in 1996 to $181 and $142 ($171 adjusted for inflation) in 1996 to $225 for preventive/ diagnostic procedures and restorative procedures, re-spectively, in 2004.

Expenses for other dental procedures (periodontic, orthodontic, prosthetic, endodontic, and oral surgery) increased from $239 ($288 adjusted for inflation) in 1996 to $411 ($288 adjusted for inflation) in 2004.

Average dental expense for adults per visit by procedure category

$239

$181

$288

$181

$411

$142$151

$115$138

$171

$225$241

$0

$100

$200

$300

$400

$500

Overall Preventive/Diagnostic Restorative Other*



Medical Expenditure 95 Panel Survey page

Adults: Age 21–64

How has the percentage of adults with dental coverage changed from 1996 to 2004?

The percentage of adults with private dental coverage increased from 58% in 1996 to 60% in 2004. There was a decrease in the

percentage of adults with no dental coverage from 1996 to 2004. Percentage with dental coverage

58.1%

5.1%

36.7%

60.4%

5.3%

34.3%

0%

20%

40%

60%

80%


1996 2004


Adults: Age 21–64


There was a decrease in the percentage of adults age 45-64 with no dental coverage from 1996 to 2004.

Changes in coverage by age

A d u lts ag e 45-64

58 .7%

3.9%

37.4%

60.9%

4.7%

34.3%

0%

20%

40%

60%

80%

P riva te den ta l coverage P ub lic denta l coverage on ly N o denta l cove rage

Ad u lts ag e 21-44

57.9%

5.8%

36.3%

60.1%

5.7%

34.2%

0%

20%

40%

60%

80%


1996 2004


Adults: Age 21–64

Low- and middle-income adults had an increase in public

dental coverage only from 1996 to 2004. High-income adults had a significant increase in private

dental coverage and a decrease in no dental coverage from 1996 to 2004.


Po o r

17.3%

28.3%

54.4%

16.4%

24.5%

59.1%

0%

20%

40%

60%

80%

100%


L o w fam ily in co m e

38.3%

7.7%

54.0%

38.1%

10.7%

51.2%

0%

20%

40%

60%

80%

100%


M id d le fam ily in co m e

63.1%

1.5%

35.4%

62.5%

2.8%

34.8%

0%

20%

40%

60%

80%

100%


H ig h fam ily in co m e

73.7%

0.5%

25.8%

78.3%

0.3%

21.4%

0%

20%

40%

60%

80%

100%


1996 2004


Adults: Age 21–64

No change is noted for Hispanics or black non-Hispanics

and adults of other race categories, regardless of the type of dental coverage.

White non-Hispanic adults had an increase in private dental coverage and a decrease in no dental coverage from 1996 to 2004.


Black n o n -H isp an ic

51.4%

10.0%

38.6%

55.9%

9.2%

35.0%

0%

20%

40%

60%

80%

100%


H isp an ic

39.4%

11.6%

49.0%

39.7%

8.9%

51.5%

0%

20%

40%

60%

80%

100%


W h ite n o n -H isp an ic

62.0%

3.2%

34.8%

65.3%

3.8%

30.9%

0%

20%

40%

60%

80%

100%


O th er*

57.6%

7.6%

34.7%

61.9%

6.2%

31.9%

0%

20%

40%

60%

80%

100%


1996 2004



Adults: Age 21–64

There were no significant changes by education in the percentage of adults with private dental coverage from 1996 to 2004.


H ig h sch o o l g radu ate

55 .6%

5.4%

39.0%

56.5%

6.6%

36.9%

0%

20%

40%

60%

80%

100%

P riva te denta l coverage P ub lic denta l coverage on ly N o denta l coverage

So m e o r n o sch o o l

29.6%

14.1%

56.4%

30.6%

13.8%

55.6%

0%

20%

40%

60%

80%

100%


C o lleg e g rad u ate

70 .1%

1.8%

28.2%

71.4%

2.1%

26.5%

0%

20%

40%

60%

80%

100%


1996 2004


Chapter 4 Older Adults: Age 65 and Over


vey page 101

Older Adults: Age 65 and Over

What proportion of the older adult population has a dental visit?

In 2004, there were about 37 million older adults in the

community population of the United States.

Approximately 43% of the older adult population had at least one dental visit during the year.

The average expense was $620 per year for older adults with a dental visit, and the average number of visits was 2.7 visits per older adult for older adults with a visit (data not shown).

Total older adult population = 37 million

43.0%

57.0%

Dental visit

No dental visit



What procedures do older adults receive?

In 2004, approximately 16 million older adults with at least

one dental visit received about 74 million dental procedures in the United States.

Approximately 82% of the older adult population receiving

at least one dental visit had at least one diagnostic procedure (examination or x-ray), and about 75% of the older adult population had at least one preventive procedure (cleaning, fluoride, or sealant) during the year.

Together, approxim ely 70% of all procedures were diagnostic (42.0%) preventive (27.5%) during 2004.

Percentage of population with at least one procedure Distr tion of procedures

Tota rocedures = 74 million

14.5%

42.0%

27.5%

3.9%

.6%

7.5%

DiagnosticPreventiveRestorativeProstheticOral surgeryOther*


24.5%29.7%

11.8%13.7%

82.2%74.7%

0%

20%

40%

60%

80%

100%

Diagno

stic

Preven

tive

Restor

ative

Prosthe

ticOral

surge

ry

Other*

*Other includes periodontic (gums), endodontic (root canals), orthodontic (braces), treatment for TMD or T J (jaw pain), and bonding, whiting, or bleaching.


at or

ibu

l p

4

M


What dental providers do older adults visit?

In 2004, approximately 16 million older adults with at least

one dental visit made about 43 million visits to a dental office in the United States.

Approximately 91% of older adult dental visits were to a

general dentist.

While 3.6% of older adult dental visits were to an oral surgeon, 5.1% were to other dental providers including endodontists (dentists who perform root canals), periodontists (dentists who treat gums), or orthodontists (dentists who correct improper bites).





91.2%

1.8%

3.6%

2.6%0.7%+

G eral dentistO l surgeonO odontistP iodontistE odontist

*Non-dentist team members include dental hygienists, dental technicians, or other non-dentist dental speci ists. + Relative standard error greater than 30%


enrarthernd

al


How are dental visits distributed across the older adult population?

In 2004, the likelihood of having a dental visit varied by age, family income, race/ethnicity, and education.

Approximately 46% of older adults age 65-74 and 39% of

older adults age 75 and over had at least one dental visit during the year.

While 60% of older adults from a high-income family had at least one dental visit during the year, less than 31% of older adults from a poor- or low-income family had at least one dental visit during the year.


Age Family income

59.9%

41.1%30.5%

28.2%

0%

20%

40%

60%

80%


46.4%39.3%

0%

20%

40%

60%

80%

65-74 75 and over



Black non-Hispanics and Hispanics were less likely to have

a dental visit in 2004 than white non-Hispanic older adults or older adults of other race/ethnicity categories.

Adults with less than a high school education were less likely to have a dental visit in 2004 than college graduates.


Education Race/ethnicity

60.0%

43.4%

20.4%

0%

20%

40%

60%

80%


College graduate

38.7%47.3%

22.7%

18.1%

0%

20%

40%

60%

80%

Black non-Hispanic


Other *






y page 107


What proportion of older adults has dental coverage?

In 2004, approximately 9 million older adults or 24% of the older adult community population had private dental coverage during the year.

Approximately 70% of all older adults did not have any dental coverage.

69.9%

23.8%

6.3%



No dental coverage



How is dental coverage distributed across the older adult population?

In 2004, dental coverage varied by age, family income, race/ethnicity and education.

About 29% of 65-74 year olds and 18% of older adults age

75 and over had private dental coverage during 2004.

Older adults from a poor family or from a family with low or middle income were less likely to have private dental coverage and more likely to have no dental coverage in 2004 than older adults from a family with higher income.


Age Family income

39.3%18.0% 10.9%

58.8%

19.3%15.2%10.6%

1.8%

3.1%

71.3% 73.9% 77.6%

0%

20%

40%

60%

80%

100%


6.1%

6.5%

17.8%29.2%

64.6%75.7%

0%

20%

40%

60%

80%

100%

65-74 75 and over




Hispanic older adults were less likely to have private dental coverage in 2004 than black non-Hispanic older adults or white non-Hispanic older adults.

Older adults with less than a high school education were less likely to have private dental coverage in 2004 than college graduates.



10.8%

12.6%18.3% 3.4% 31.1%

58.1%

25.2%16.0%22.5%

64.9% 65.7% 71.4%

0%

20%

40%

60%

80%

100%

Black non-Hispanic


Other*

13.6%

74.4% 73.2%63.4%

33.6%23.0%

12.0%

3.8%

3.0%

0%

20%

40%

60%

80%

100%

Some or noschool

High schoolgraduate

College graduate






In 2004, while 65% of the older adult population with private dental coverage had a dental visit, 26% of the older adult population

with public dental coverage only had a dental visit and 37% of the older adult population without any dental coverage had a dental visit.



2.952.60

2.892.72

0

1

2

3

4



No dental coverage

26.3%

37.0%

65.0%

43.0%

0%

20%

40%

60%

80%



No dentalcoverage




In 2004, the total dental expense for the older adult

community population of the United States was $10 billion (data not shown).

The average annual expense was $620 for older adults with a dental visit during 2004.

Average annual dental expense for persons with a dental visit

$535 $528

$824

$620

$0

$200

$400

$600

$800

$1,000



No dentalcoverage



Se 3: Changes from 1996 to 2004


ction


How has the percentage of the older adult population with a dental visit changed from 1996 to 2004?

There was no significant change in the percentage of the older adult population with a dental visit from 1996 to 2004.


40.3%43.0%

0%

20%

40%

60%

1996 2004



Adults age 75 and older were more likely to have a dental visit in 2004 than in 1996.


Age Income

46.9%

32.2%

46.4%

39.3%

0%

20%

40%

60%

80%

65-74 75 and over

24.0%28.6%

43.6%

57.8%

28.2% 30.5%

41.1%

59.9%

0%

20%

40%

60%

80%


1996 2004



No significant changes by race/ethnicity or education in the percentage of older adults with a dental visit from 1996 to 2004 were

noted.



25.1%

38.7%

31.8%

16.7%

43.6%47.3%

18.0%22.7%

0%

20%

40%

60%

80%

B lack non-H ispanic

H ispanic W hite non-H ispan ic

O ther*

45.2%

23.7%

61.4% 60.0%

20.4%

43.4%

0%

20%

40%

60%

80%

Som e or no schoo l H igh schoolgraduate

College graduate

1996 2004




Older adults with public dental coverage only were more likely to have a dental visit in 2004 than in 1996.


64.8%

15.4%

37.0%34.9%

26.3%

65.0%

0%

20%

40%

60%

80%



No dental coverage

1996 2004




There was no statistically significant change in the average number of dental visits per older adult for those with a dental visit from 1996 to 2004.


Average number of dental visits for older adults with a visit

Average dental expense for older adults with a dental visit

$620

$438

$527

$0

$200

$400

$600

$800


2004

2.92 2.72

0

1

2

3

4

1996 2004



How have average visits per older adult for those with a dental visit changed from 1996 to 2004?

There were no statistically significant changes by age or income in the number of visits by older adults with a dental visit from 1996 to 2004.


3.032.732.74 2.69

0

1

2

3

4

65-74 75 and over

Age Income

2.63 2.62

3.04 3.032.96

2.55 2.612.82

0

1

2

3

4


1996 2004



No significant changes by race/ethnicity or education in the average number of visits for older adults with a dental visit from 1996

to 2004 were noted.


2.59

2.973.11

2.402.64

2.84

0

1

2

3

4

Some or noschool

High schoolgraduate

College graduate


3.012.79

2.93

2.542.27

2.40

2.76

2.41

0

1

2

3

4

Black non-Hispanic


Other*

1996 2004




No significant changes by dental coverage status in the average number of visits by older adults with a dental visit from 1996 to

2004 were noted.


3.24

2.562.74

2.89 2.952.60

0

1

2

3

4



No dentalcoverage

1996 2004




For high-income older adults, the average expense (adjusted for inflation) increased from 1996 to 2004.


Age Income

$454$409

$493$547

$601$636

$0

$200

$400

$600

$800

$1,000

65-74 75 and over

$612

$508

$360

$441

$339$409$434

$532

$691

$550$491

$822

$0

$200

$400

$600

$800

$1,000





For white non-Hispanics and college graduates, the average expense (adjusted for inflation) increased from 1996 to 2004.



$553

$459$452$414

$498$544

$684

$552$549

$0

$200

$400

$600

$800

Less than highschool

High schoolgraduate

College graduate

$527

$438

$534

$435

$335

$403

$643

$524$557

$630$656

$407

$0

$200

$400

$600

$800

Black non-Hispanic


Other*





No significant change (adjusted for inflation) was observed from 1996 to 2004 in average dental expense for older adults with a

dental visit, regardless of type of dental coverage.

Average dental expense for older adults with a dental visit

$552

$432$367

$664

$520$442

$817

$518 $510

$0

$200

$400

$600

$800

$1,000



No dentalcoverage


Medical Exp
enditure Panel Survey page 124



Older adults were less likely to have at least one restorative or other procedure in 2004 than in 1996. Percentage of population with at least one procedure

2 9 .8 %3 3 .4 %

1 5 .9 %

8 2 .2 %

7 4 .7 %

2 4 .5 %

2 9 .7 %

1 3 .7 %1 1 .8 %

1 4 .0 %

7 8 .8 %

7 1 .4 %

0 %

2 0 %

4 0 %

6 0 %

8 0 %

1 0 0 %

ia g n o s t ic P re ve n t ive R e s to ra t ive P ro s th e t ic O ra l s u rg e ry O th e r*

1996 2004

*Other includbleaching.

Medical Expe

D

es periodontic (gums), endodontic (root canals), orthodontic (braces), treatment for TMD or TMJ (jaw pain), and bonding, whiting, or

nditure Panel Survey page 125



For older adults, the total number of procedures increased from about 64 million in 1996 to about 74 million in 2004 (data not shown).

As a percentage of all procedures, from 1996 to 2004 diagnostic procedures increased while restorative procedure types decreased.


9 .6%

4 .8 % 5 .6 %

38 .3%

1 6 .1%

25 .7%

4 .6 %3 .9 %

1 4 .5%

7.5%

2 7 .5%

42 .0 %

0 %

10 %

20 %

30 %

40 %

50 %

D iagnos tic P reven tive R es to ra tive P ros the tic O ra l su rge ry O the r*

1996 2004

*Other includes treatment for TMD or TMJ (jaw pain), bonding, whiting, or bleaching.*Other includes periodontic (gums), endodontic (root canals), orthodontic (braces), treatment for TMD or TMJ (jaw pain), and bonding, whiting, or bleaching.




For older adults, average dental expenses increased from $124 ($149 adjusted for inflation) in 1996 to $184 for restorative procedures in 2004.

Expenses for othe ental procedures (periodontic, orthodontic, prost ic, endodontic, and oral surgery) increased from $1 ($233 adjusted for inflation) in 1996 to $403 in 2004.

Average dental expense for older adults per visit by pro dure category

$194$181

$233

$156

$403

$124$150

$134

$161$149

$184

$230

$0

$100

$200

$300

$400

$500

Overall Preventive/Diagnostic Restorative Other*


*Other includes periodontic (gums), endodontic (root canals), prosthetic (crown, bridges, and dentures), hodontic (braces), oral surgery, treatment for TMD or TMJ (jaw pain), and bonding, whiting, or bleaching.


r dhet94

ce

04

ort


How has the percentage of older adults with dental coverage changed from 1996 to 2004?

There were no significant changes in the percentage of older adults with private, public only, or no dental coverage from 1996 to

2004. Percentage with dental coverage

23.2%

7.9%

68.9%

23.8%

6.3%

69.9%

0%

20%

40%

60%

80%


1996 2004




No significant changes by age in the percentage of older adults with private dental coverage from 1996 to 2004 were noted.

Changes in coverage by age

A d u lts age 75 an d ab o ve

16 .7%

7.8%

75.5%

17.8%

6.5%

75.7%

0%

20%

40%

60%

80%


Ad u lts ag e 65-74

28.6%

8.0%

63.4%

29.2%

6.1%

64.6%

0%

20%

40%

60%

80%


1996 2004



Older adults from a middle-income family were less likely to have private dental coverage and more likely to have no dental

coverage than older adults from a family with either lower or higher income in 2004 than in 1996. .


P oor

11 .9%

20.0%

68.1%

10.6%

18.0%

71.3%

0%

20%

40%

60%

80%

100%

P riva te denta l coverage P ub lic denta l cove rage on ly N o denta l coverage

Low fam ily incom e

12 .3% 10.8%

77.0%

15.2%10.9%

73.9%

0%

20%

40%

60%

80%

100%


M idd le fam ily incom e

28 .5%

4.5%

67.0%

19.3%

3.1%

77.6%

0%

20%

40%

60%

80%

100%

P riva te denta l coverage P ub lic denta l cove rage on ly N o denta l cove rage

H igh fam ily incom e

34 .8%

3.3%

61.9%

39.3%

1.8%

58.8%

0%

20%

40%

60%

80%

100%


1996 2004



Black non-Hispanic older adults had a significant increase

in the likelihood of having private dental coverage from 1996 to 2004.

White non-Hispanic older adults had a significant decrease in the likelihood of having public dental coverage only from 1996 to 2004.


H ispan ic

14 .4%

26.1%

59.5%

16.0% 18.2%

65.7%

0%

20%

40%

60%

80%

100%


B lack non-H ispan ic

12 .5%18.4%

69.2%

22.5%

12.6%

64.9%

0%

20%

40%

60%

80%

100%

denta l coverage P ub lic denta l cove rage on ly N o denta l coverage

W hite non-H ispan ic

6%

5.1%

70.3%

25.2%

3 .4%

71.4%

0%

20%

40%

60%

80%

100%

denta l coverage P ub lic denta l coverage on ly N o den ta l coverage

O th er*

25.4%32.2%

42.4%

10.8%

31.1%

58.1%

0%

20%

40%

60%

80%

100%


*OtheHawa

Medic

P riva te

24 .

P riva te

1996 2004

r includes non-Hispanics who reported to be of single race other than white or black (i.e., American Indian/Alaska Native, Asian, or Native iian/Pacific Islander) as well as non-Hispanics who reported to be of multiple races (possibly including black).

al Expenditure Panel Survey page 131


There were no statistically significant changes by education in the percentage of older adults with private dental coverage from 1996 to 2004.


S om e or no school

14 .1% 13.4%

72.4%

1 2.0% 13.6%

7 4.4%

0 %

20%

40%

60%

80%

100%

P riva te denta l coverage P ub lic denta l cove rage on ly N o denta l cove rage

H igh schoo l g raduate

26 .4%

5.0%

68.6%

23.0%

3.8%

73.2%

0%

20%

40%

60%

80%

100%


C ollege graduate

34 .0%

3.1%

62.9%

33.6%

3.0%

63.4%

Med

0%

20%

40%

60%

80%

100%


1996 2004

ical Expenditure Panel Survey page 132

References

Cohen J. Design and methods of the Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027.

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, July 2003: 41(7) Supplement: lll-5- lll-12. Brown E, Manski R. Dental services: use, expenses, and sources of payment, using data from the 1996-2000. Rockville(MD): Agency for Healthcare Research and Quality; 2003. MEPS Research Findings 20. AHRQ Pub. No. 04-0018. Monheit AC, Wilson R, Arnett RH. Informing American health care policy: the dynamics of medical expenditure and insurance surveys, 1977-1996. San Francisco: Jossey-Bass, 1999.

Please consult the MEPS Web site (http://www.meps.ahrq.gov) for an updated publications list and other information from MEPS. For additional information, contact the MEPS project director at [email protected].



mailto:[email protected]

Definitions of Terms

Dental Visit

This refers to care by or visits to any type of dental care provider, including general dentists, dental hygienists, dental technicians, dental surgeons, orthodontists, endodontists, and periodontists. Dental Coverage Variables

Respondents were asked if they were covered by a private health insurance plan that included at least some dental coverage for each round of 1996 and 2004. This information was elicited from a pick-list, code-all-that-apply question that asked what type of health insurance the person obtained through an establishment. The list included hospital and physician benefits, including coverage through an HMO, Medigap coverage, vision coverage, dental, and prescription drugs. It is possible that some dental coverage provided by hospital and physician plans was not independently enumerated in this question. Persons with missing information on dental benefits for all reported private plans and those who reported that they did not have dental coverage for one or more plans but had missing information on other plans are coded as not having private dental coverage. Respondents who reported dental coverage from at least one reported private plan were coded as having private dental coverage.

The variable for dental coverage indicates if a participant was eligible to receive and/or actually received payments on their behalf for dental care obtained during 1996 and 2004. More specifically, an individual is considered to have dental coverage with a self or proxy report of dental coverage at any time during 1996 or 2004. An individual may or may not have full year coverage. An individual is also considered to have dental coverage with a self or proxy report of an insurance payment for dental care received. While Medicaid/SCHIP provides medical care coverage for all enrolled children, Medicaid/SCHIP dental coverage often varies in scope or reimburse-ment level among the different states. The variable for Medicaid/SCHIP dental coverage indicates if a participant was enrolled (eligible and enrolled) to receive dental Medicaid/SCHIP coverage and/or actually received Medicaid/SCHIP payments on their behalf for dental care obtained during 1996 and 2004. Specifically, for 1996 an individual is considered to have Medicaid dental coverage with a self or proxy report of Medicaid coverage at any time during 1996 consistent with 1989 OBRA and state regulations and state eligibility expansions. For instance, pregnant women in families with a poverty status up to 133% of the Federal poverty level (FPL), children up to age 6 in families with a poverty status at least up to 133% FPL, and children up to age 14 in families with a


poverty status at least up to 100% FPL are considered to have Medicaid dental coverage if they have a report of Medicaid coverage. Additionally, persons residing in states that expanded Medicaid eligibility beyond these minimum income requirements are considered Medicaid covered if they reside in an “expansion state” and report Medicaid coverage. Expansion states for 1996 include California, Connecticut, Indiana, Iowa, Maine, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Washington, and Wisconsin. Persons who qualify as Medicaid covered at any of the three MEPS interviews are considered to be covered. For 2004, an individual is considered to have Medicaid/SCHIP dental coverage with a self or proxy report of Medicaid/SCHIP coverage at any time during 2004 consistent with state regulations and state eligibility expansions. An individual may or may not have full-year coverage. In some states, dental SCHIP coverage was limited or absent during 2004. Persons residing in states that excluded dental SCHIP are considered to have no public coverage if not eligible for Medicaid. Delaware and Texas are SCHIP dental excluded states. Persons who qualify as Medicaid/SCHIP covered at any of the three MEPS interviews are considered to be covered. Addition-ally, persons residing in states that expanded Medicaid eligibility beyond these minimum income requirements are considered Medicaid covered if they reside in an “expansion state” and report Medicaid coverage. Expansion states for 2004 include California, Connecticut, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Minnesota, Missouri,

Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, and Wisconsin. For 2004, an individual is considered to have no dental coverage if an individual has no report of private or public dental coverage at any time during the year. Education

Education* is expressed in terms of years or formal education. In this chartbook, the following classification was used: • Some or no school—Less than 12 years of formal

education • High school graduate —12 years of formal

education • College graduate—More than 12 years of formal

education *For children 20 years of age and younger, education refers to a caregiver’s (parent or guardian) education. Expenses

Dental expenditures (expenses). In this report, expenditures are the amount actually paid for dental services. More specifically, in MEPS, expenditures are defined as the sum of payments for care received, including out-of-pocket payments and payments made by private insurance, Medicaid, Medicare, and other sources. This definition of expenditures differs somewhat from the definition used in predecessor surveys, the


1987 National Medical Expenditure Survey (NMES) and the 1977 National Medical Care Expenditure Survey, in which charges rather than payments were used to measure medical expenditures. Users who wish to compare the expenditure data presented in this report with data from the 1987 and/or 1977 surveys should consult Monheit, Wilson, and Arnett (1999). AHRQ has developed factors to apply to the 1987 NMCES expenditure data to facilitate longitudinal analysis. These can be accessed via the AHRQ Data Center; for information on applying to the AHRQ Data Center see http://www.meps.ahrq.gov/ mepsweb/data_stats/onsite_datacenter.jsp. Details on the editing and imputation methodology used to develop the dental expenditure variables presented in this report can be found in the documentation for the dental event files. See http://www.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h85b/h85bdoc.shtml for the 2004 dental event file link.

It should also be noted that it is common for several dental visits to be included in a single fee. These “flat fees” are particularly common for orthodontia and some types of dental reconstruction and surgery. The flat fee groups may cross calendar years. For flat fees, expenses for the entire episode are placed on the initial event. For comparison purposes, an expen-diture amount adjusted for inflation is provided. Specifically, 1996 expenditures are adjusted to 2004 using a Bureau of Labor Statistics derived factor of 1.20 (our adjustment was calculated as follows: the CPI is 156.9 for 1996 and 188.9 for 2004; so the adjustment factor is 188.9/156.9=1.204).

Income

Income is expressed in terms of poverty status, the ratio of the family’s income to the Federal poverty thresholds, which control for the size of the family and the age of the head of the family (see the 2004 U.S. Department of Health and Human Services Poverty Guidelines at http://aspe.hhs.gov/poverty/ 04poverty.shtml for more details). In this chartbook, the following classification was used: Poor—Persons in families with income less than or equal to 100% of the poverty line are considered poor. Some of these persons are in families reporting negative income. Low income—Persons in families with income over 100% through 200% of the poverty line are considered low income. Middle income—Persons in families with income over 200% through 400% of the poverty line are considered middle income. High income—Persons in families with income over 400% of the poverty line are considered high income. Procedures

Procedures refer to at least one procedure type per visit. Multiple procedures of the same type at the same visit are not included. Other service types not identified by respondents are not included.

Diagnostic = Includes examinations and x-rays Preventive = Includes cleanings, fluoride, sealants and recall visits Restorative = Fillings and inlays


Prosthetic = Crowns, bridges, dentures, repairs and implants Periodontic = Periodontic services only Endodontic = Endodontic services only Orthodontic = Orthodontic services only Other = Any other dental service not included above Population Characteristics

In general, population characteristics were measured as of December 31st of the year of study (1996 or 2004), or the last date that the sample person was part of the civilian noninstitutionalized (community) population living in the United States prior to December 31st of that year.

Comparisons by race/ethnicity in this chartbook are based on the following four race/ethnicity groups: black non-Hispanic, white non-Hispanic, Hispanic, and other. Other includes non-Hispanics who reported being of a single race other than white or black (i.e., American Indian/Alaska Native, Asian, or Native Hawaiian/ Pacific Islander) as well as non-Hispanics who reported to be of multiple races (possibly including black). Caution should be used when drawing conclusions based on comparisons of race/ethnicity groups for 2004 versus 1996 because the true racial composition of each of the identified race/ethnicity groups cannot be guaranteed to be the same across these years.

w: Medicare/Non-Medicare


Documents

Chartbook #17: Dental Use, Expenses, Dental Coverage, and … · 2020-03-06 · t t Dental Use, Expenses, Dental Coverage, and Changes, M EPS Charbook N o.17 M edicalExpendiure PanelSurvey