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Dental Utilization for Communities Served by Dental Therapists in Alaska’s Yukon Kuskokwim Delta: Findings from an Observational Quantitative Study

August 11, 2017
By Donald L. Chi

This study examines whether dental utilization rates in Alaska Native communities were associated with the number of dental therapist treatment days.

Background. Dental Therapists have provided preventive and restorative dental care in Yukon Kuskokwim (YK) Delta communities since 2005. In this retrospective program evaluation, there were two goals: (1) to examine whether dental utilization rates in Alaska Native communities were associated with the number of Dental Therapist treatment days; and (2) to quantify differences in dental utilization rates between communities with no Dental Therapist treatment days versus communities with the highest number of Dental Therapist treatment days during the study period.

Methods. We analyzed Yukon Kuskokwim Health Corporation dental clinic electronic health record (EHR) data and Medicaid claims data (10 years, spanning from 2006 to 2015). We identified all dental services provided by Dental Therapists in the YK Delta using EHR data to calculate the total number of Dental Therapist treatment days provided in each community during the study period. Based on the number of Dental Therapist treatments days, we identified communities with no Dental Therapist treatment days and communities with the highest number of Dental Therapist treatment days.

We assessed five outcomes at the community-level using both EHR and Medicaid data. The three child outcomes were: preventive dental care use, extraction of the four front teeth (D-E-F-G), and dental care under general anesthesia. The two adult outcomes were: preventive dental care use and extraction of any teeth. There were two questions: (1) Is the total number of Dental Therapist treatment days associated with dental utilization? and (2) What are the differences in dental utilization between communities with no Dental Therapist treatment days and communities with the highest number of Dental Therapist treatment days? For question one, we calculated Spearman partial correlation coefficients, adjusted for two confounders (number of dentist treatment days and baseline poverty). For question two, we compared percent differences.

Results. During the study period, there were 13 Dental Therapists who provided 9,012 days of treatment.

Based on EHR and Medicaid data, increased Dental Therapist treatment days was significantly associated with:

• More children and adults who received preventive care

• Fewer children under age 3 with extractions of the front four teeth

• Fewer adults ages 18 and older with permanent tooth extractions

In the EHR data, increased Dental Therapist treatment days was significantly associated with fewer children with dental care under general anesthesia for children under age 6. However, in the Medicaid data, Dental Therapist treatment days was not significantly associated with dental care under general anesthesia.

Consistent across both datasets, preventive care rates were higher and treatment rates were lower in communities with the highest number of Dental Therapist treatment days. Child and adult preventive care utilization rates were 9.3 to 16.4 percentage points and 2.4 to 11.8 percentage points higher in communities with the highest number of Dental Therapist treatment days, respectively, compared to communities with no Dental Therapist treatment days. D-E-F-G extraction rates for children were 5.4 to 15.2 percentage points lower, child general anesthesia rates were 2.4 to 3.1 percentage points lower, and adult extraction rates were 2.5 to 13.5 percentage points lower in communities with the highest number of Dental Therapist treatment days.

Conclusions. Increased Dental Therapists treatment days at the community-level in the YK Delta were positively associated with preventive care use and negatively associated with extractions. Dental Therapists treatment days were not associated with increased general anesthesia rates for children. There appear to be clinically meaningful differences between communities with no Dental Therapists and communities with the highest number of Dental Therapist treatment days, with the latter communities exhibiting utilization patterns consistent with improved outcomes (e.g., more preventive care, fewer extractions, less general anesthesia).