Stability of oral health status in a long-term care population: A longitudinal analysis of dental utilization

Objective. To investigate patterns and predictors of dental service utilization over time among an institutionalized elderly population receiving comprehensive care on a regular basis.; Methods. Data were drawn from dental records of 868 dentate nursing home residents who had received comprehensive dental services over a minimum of 24 months. The number, type and cost of services were analyzed for each treatment period bounded by periodic examinations. Characteristics of long-term care facility residents (presenting dental condition, age, sex, functional status, and payer source) and facility characteristics (ownership type and size) were utilized as explanatory variables. Stability status (stable = only diagnostic and preventive services needed) was established for each treatment period. Stability status was assigned at the person level based on treatment needs at the first periodic examination following completion of the initial treatment plan. Repeated measures analysis was used to identify predictors of stability and dental utilization over time.; Results. Female sex and requiring fewer services initially were positively associated with stability at first periodic examination, as well as stability over time. Age was negatively associated with stability over time. A previous period's stability status predicted subsequent stability.; Dental service utilization demonstrates consistent patterns over time. Regardless of stability status, total services and costs peaked for all service types in the initial treatment phase. Subsequently, utilization dropped and remained relatively constant over time. The analysis demonstrates that higher costs occur in all service categories for residents receiving dental services for the first time in the nursing home setting. Declining health status or catastrophic health events that precede nursing home placement overshadow oral health concerns. The resultant neglect lasting for many months or years may result in the newly admitted nursing home resident presenting with dramatic oral health needs. Restoring such mouths to a state of stability requires substantial resources. However, once the backlog of unmet need is addressed, the maintenance costs are reduced substantially and remain relatively constant over time. Those who remain in a non-stable status will require more services at greater cost than those for whom oral health stability was achieved earlier.