Background. Racial disparities have been widely documented in medical care, but variations in dental care have not been well examined.
Objectives. To determine if there is racial variation in use of root canal therapy versus tooth extraction across different levels of dental insurance coverage and adjusting for other factors known to influence treatment decisions.
Methods. Within 3 different categories of insurance coverage, we examined whether there were racial differences in the provision of the tooth-sparing treatment of root canal therapy (vs. tooth extraction) among 54,423 users of outpatient Veterans Affairs dental care in 1998. Regression analyses adjusted for the severity of tooth- and gum-related disease, age, sex, medical and psychiatric comorbidities, prior use of preventive dental services, tooth extraction and root canal therapy, and clustering by geographic region.
Results. In the adjusted regression models, black patients and those with unknown race were less likely overall to receive root canal therapy than whites, whereas Asians were more likely. Among patients with eligibility for continuing and comprehensive dental care, blacks were less likely and Asians more likely to receive root canals than whites. For patients covered only for emergency dental care, Hispanics had a higher likelihood of receiving root canal therapy. Among all other types of coverage, there were no significant racial differences in the care received.
Conclusion. We observed substantial racial variations in the provision of root canal therapy among patients treated in Department of Veterans Affairs dental clinics. Future research should identify the causes of such variations.
Racial variations in medical care are well documented, 1–3 but such research has rarely focused on dental care. Epidemiologic evidence indicates that blacks have disproportionately more dental caries and tooth loss than non-Hispanic whites, 4 as do impoverished individuals, older adults, 5 and older veterans. 6 To prevent such tooth loss, dental practice increasingly favors root canal therapy versus tooth extraction.
We sought to determine if there are racial variations in rates of root canal therapy in the Department of Veterans Affairs (VA) dental care system, and whether observed variations persisted across different types of insurance coverage, controlling for factors known to influence such treatment decisions.
From the *Center for Health Quality, Outcomes and Economic Research, Veterans Affairs Medical Center, Bedford, Massachusetts.
From the †Health Services Department, Boston University School of Public Health, Boston, Massachusetts.
From ‡Goldman School of Dental Medicine, Boston University, Boston, Massachusetts.
This research was supported by grants from the Department of Veterans Affairs (VA) Health Services Research and Development Service (IIR IIR-98-161.1, Judith A. Jones, Primary Investigator [PI]) and from the Northeastern Minority Oral Health Research Center, a NIDCR Regional Research Center for Minority Oral Health (Grant #T50-DE10592, Ralph Katz, PI) to Nancy Kressin. Dr. Kressin is a Department of Veterans Affairs Health Services Research and Development Career Scientist; and at the time of this work, Dr. Jones was an Associate in the Career Development Program of the Department of Veterans Affairs Health Services Research and Development Service.
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Address correspondence and reprint requests to: Nancy R. Kressin, PhD, Center for Health Quality, Outcomes and Economic Research, VA Medical Center, 200 Springs Road, Building 70 (152), Bedford, MA 01730. E-mail: email@example.com