The Oral Health Status of Hospitalized Populations: A Clinical Pilot and Evaluation of Insurance Claims Data

Abstract

Background: Poor oral health has been associated with worse outcomes among hospitalized patients, but access to oral healthcare services in the hospital setting is limited. It is unknown how a hospital admission affects oral health or subsequent dental utilization. Methods: This thesis is composed of two preliminary studies on the oral health status of patients with a hospital stay. In the first part of the thesis, all patients meeting inclusion criteria on the general medicine service of a tertiary care hospital were invited to participate in an oral evaluation by a licensed dental hygienist. Subjects were asked about their access to dental care and perceptions of their oral health. A dental hygienist conducted examinations including decayed, missing, and filled teeth (DMFT) and periodontal screening and recording (PSR) indices on a subset of subjects. In the second part of this thesis, a retrospective analysis of insurance claims data from a national private insurer was conducted. Individuals were included if they were admitted to the hospital and had visited a dentist at least once in the year before admission. Total number of dental visits as well as CDT codes associated with these visits in the year before and after a hospital stay, patient demographics, and hospital admission diagnosis and length of stay were recorded. Differences in utilization before and after the hospital stay were calculated. Results: For part 1 of this thesis, The 105 subjects had a mean age of 69±13 and a median hemoglobin A1c of 7.5±2.1%. Rates of comorbidity and polypharmacy were high. Mean DMFT was 23.0±7.3 with 10.1±7.3 missing teeth. 44% of subjects had a removable prosthesis. 68% of subjects had a PSR of 4 or greater in at least one sextant, indicating moderate periodontal disease. For part 2 of this thesis, 107,116 individuals met inclusion criteria. There were significantly fewer dental visits after admission, 1.92±1.80, compared to prior to admission, 1.58±1.74 (p<0.0001). There were significantly fewer procedures performed in the year after discharge (8.53±12.53 total CDT codes in the year before admission and 7.03±11.38 in the year after discharge, p<0.0001). Rates of diagnostic and restorative services delivered was higher after admission, while rates of periodontic, endodontic, oral surgery, and prosthodontic services decreased (overall Pearson’s X2 p<0.0001). Conclusions: Rates of missing teeth, removable prostheses, and periodontal inflammation were high among hospitalized patients with diabetes, but patients did not perceive their oral health to be poor. Patients are less likely to visit a dentist following a hospital stay, and are less likely to receive more invasive dental care if they do. Healthcare providers should be aware of the oral health risks of patients during hospitalization, and dentists should consider screening patients with diabetes for recent hospitalization.