Other
Drew R. Horton, DDS, MHA
Pediatric Dental Resident
Primary Children’s Hospital
Primary Children's Hospital
Park City, Utah, United States
Hans C. Reinemer, DMD, MS
Residency Program Director
Primary Children's Hospital
Salt Lake City, Utah, United States
Hans C. Reinemer, DMD, MS
Residency Program Director
Primary Children's Hospital
Salt Lake City, Utah, United States
Purpose: To identify preliminary evidence of geographic variation, which has been well documented in medical literature, within the practice of pediatric dentistry with the goal of increasing awareness and initiating health policy conversations about the oral health and macro-economic implications.
Methods: Dental insurance claims data were obtained through the Utah All Payer Claims Database for the year 2018. Twelve ZIP codes were selected from the state of Utah representing regions with differing demographics. Medicaid procedure rates specific to pulpotomies (D3220) and stainless-steel crowns (D2930) for children ages 0-11 were compared between ZIP codes using the z-test for independent proportions.
Results: Variations were identified between ZIP codes in pulpotomy rates (3.7 to 46.9 per 100 Medicaid-eligible children) and SSC rates (12.7 to 88.2 per 100 Medicaid-eligible children). Pulp/SSC ratios ranged from 24.6% to 70.6%. Statistically significant variations were noted between ZIP codes (P < .001) for both pulpotomies and stainless-steel crowns. Scatter plots were used to evaluate confounding variables including median income, education level, water fluoridation and ethnic diversity, which provided supporting evidence that these co-factors alone do not account for the observed variation.
Conclusions: Unwarranted variation refers to differences in practice patterns between geographic regions which cannot be explained by socioeconomic status, evidence-based care, population needs or patient preferences. This study identifies preliminary evidence of geographic variation in pediatric dental practice patterns in Utah which warrants further research and funding for population level studies given the important oral health policy and Medicaid funding implications of this issue.