Oral health is an essential part of a person’s overall health. Poor oral health can lead to pain, discomfort and infections. It can also hinder the ability to speak, eat, learn and work.
Untreated tooth decay is a serious problem across the United States. In 2011–2012, around 15% of children and adolescents ages 8–17 and 25% of adults ages 35–44 had untreated dental caries (cavities). Without treatment, these cavities may become serious and need emergency treatment. In fact, oral health-related emergency department visits nearly doubled from 2000 to 2010, from 1.1 million to 2.1 million.
Emergency dental care received in hospital settings is costly and inefficient. While emergency dental care may lessen a person’s immediate pain, most hospital emergency visits do little to solve the dental problem, requiring a dental referral for further evaluation and treatment. Early and regular dental care prevents the need for emergency dental care in a hospital setting.
The oral health of Iowans is similar to the rest of the US. According to a 2016 survey, nearly 30% of Iowa adults have not been to a dentist in the last year, slightly below the national average. Nearly one in five adults is missing all of their teeth (17%), whereas three in four children report excellent or very good teeth (72%).
Routine dental visits are essential for ensuring optimal oral health. Dental exams and X-rays can help identify issues early before they become severe and require more advanced treatment. Services such as cleanings and fluoride and sealant applications have been proven to prevent gum disease and tooth decay.
In addition to dental visits, following these practices can help keep your mouth healthy:
Eat a healthy diet, especially one avoiding sugary foods and beverages
Avoid tobacco use
Practice proper home care, including daily brushing and flossing
Reporting oral health-related hospitalizations and emergency department visits, as well as dental services provided to at-risk populations, helps Iowans better understand who is receiving preventive care, those with serious dental problems and the populations most in need of assistance to access care.
This page provides general information about oral health data and measures developed by the Iowa Public Health Tracking program. Contact us for more information about these data.
Iowa Hospitalization and Emergency Department Visit Data
Iowa Hospitalization and Emergency Department Visit data tell us:
The numbers and rates of oral health hospitalizations and emergency department visits in Iowa by year, age group and sex.
If the numbers and rates of oral health hospitalizations and emergency department visits are going up or down over time.
If a segment of a population is at higher risk for hospitalization or a visit to the emergency department due to oral health problems.
Child Dental Services (Medicaid) Data
Child Dental Services (Medicaid) data tell us:
The numbers and rates of Medicaid-reimbursed dental services for children ages 0–20 in Iowa by year, age group and county.
If services by a provider type are going up or down over time.
If a segment of the Medicaid-enrolled children ages 0–20 population is less likely to visit a dentist or get routine preventive dental care within a year.
To inform the public about hospitalizations and emergency department visits for dental issues.
To inform the public about Medicaid-enrolled children’s access to dental services.
For program planning and evaluation by state and local partners.
Iowa Hospitalization and Emergency Department Visit Data
Iowa Hospitalization and Emergency Department Visit data do not tell us:
What causes oral health problems, or what leads to oral health hospitalizations and emergency department visits.
The total burden of oral health problems in a population.
The number of people who are hospitalized or who visited an emergency department for an oral health problem. Because personal identifiers are removed from the hospital discharge data before analysis, individuals who have multiple hospitalizations or emergency department visits cannot be identified.
Child Dental Services (Medicaid) Data
Child Dental Services (Medicaid) data do not tell us:
The specific type of services received by Medicaid-enrolled Iowa children.
The provider of the service (medical or dental professional).
Hospitalization and emergency department data are collected by the Iowa Hospital Association on behalf of Iowa HHS in accordance with Iowa Code section 135.166.
Bridged-race population estimates from the National Center for Health Statistics and US Census. Data from 2000 to 2009 are based on intercensal population estimates and 2010–most current year are based on the postcensal population estimates.
Child Dental Services (Medicaid) data are collected by Iowa Medicaid Enterprise (IME), submitted to the Center for Medicaid and Medicare Services (CMS), and reported to Iowa HHS via IME per their interagency agreement.
The Iowa Public Health Tracking portal displays hospitalization data from the year 2000 through the most recent year of data available.
The Iowa Public Health Tracking portal displays Emergency Department visit data from the year 2003 through the most recent year of data available.
There is usually a two-year lag period before hospitalization and emergency department visit data are available.
The Iowa Public Health Tracking portal displays Child Dental Services (Medicaid) data from the year 2010 through the most recent year of data available.
Child Dental Services (Medicaid) data is presented in Federal Fiscal Year (ex. “2017” runs October 1, 2016–September 30, 2017).
There is usually a six-month lag period before Child Dental Services (Medicaid) data are available.
Hospitalizations are defined as Iowa residents who are discharged from a hospital in Iowa.
Emergency Department visits are defined as Iowa residents who are treated and released or subsequently admitted to a hospital in Iowa.
Oral health hospitalizations have a primary discharge diagnosis of an oral health problem.
Oral health emergency department visits have an oral health problem as the first-listed diagnosis.
Oral health problems are defined as the International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) codes that begin with 520-528.
Oral health problems are defined as the International Classification of Disease 10th Revision, Clinical Modification (ICD-10-CM) codes that begin with K00-K13, M26, or M27.
"Any dental service" is defined as a service with a Medicaid-reimbursed dental code between 00100-09999 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC) or from a Title V screening center or maternal health center (public health organization having a contract with Iowa HHS for local child or maternal health services).
"Preventive dental service" is defined as a service with a Medicaid-reimbursed dental code between 1000-1999 provided in a dental office or clinic, a Federally Qualified Health Center (FQHC) or from a Title V screening center or maternal health center.
"Dental Treatment Services" are defined as services with a Medicaid-reimbursed dental code between 2000-9999 provided in a dental office or clinic or a Federally Qualified Health Center (FQHC).
"Sealant on a Permanent Molar Tooth" is defined as a service with a Medicaid-reimbursed dental code of 1351 provided to children ages 6-14 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC) or from a Title V screening center or maternal health center.
"Diagnostic Dental Services" are defined as services with a Medicaid-reimbursed dental code between 0100-0999 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC) or from a Title V screening center or maternal health center.
"An oral health service by a medical professional" is defined as a service with a Medicaid-reimbursed dental code between 00100-01999 or CPT code 99188 and provided in a medical office or by nurses working in a Title V screening center or maternal health center (public health organizations having a contract with Iowa HHS for local child or maternal health services).
"Any dental or oral health service" is defined as a service with a Medicaid-reimbursed dental code between 00100-09999 or CPT code 99188 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC), a medical office or from a Title V screening center or maternal health center.
Important Note: Prior to 2013, services provided by dental hygienists working in Title V screening centers or maternal health centers were captured as “oral health services by a medical professional” and caution should be taken if comparing 2012 and earlier to 2013 and later.
Number:
If you want to understand the magnitude or how big the overall burden is, then use the number.
The number indicates the total number of hospitalizations or emergency department visits due to an oral health problem, but not the number of unique individuals hospitalized or who visited the emergency department.
To protect an individual's privacy, counts of 5 or less are suppressed.
Crude Rate:
If you want to understand the probability or what is the underlying risk in a population, then use a rate.
In our analysis a rate is calculated using a numerator, the number of oral health hospitalizations during a period of time, divided by a denominator, the number of people in a population during the same period of time. This fraction is then multiplied by 10,000 to provide a more recognizable value.
To protect an individual's privacy, rates based on counts of 5 or less are suppressed.
Age-adjusted rate:
Age-adjusted rates are useful when comparing the rates of two population groups that have different age distributions.
A weighted average, called the direct method, is used to adjust for age in this analysis. Age specific rates in a given population are adjusted to the age distribution in a standard population by applying weight. The U.S. 2000 Standard population is used as the basis for weight calculations.
To protect an individual's privacy, rates based on counts of 5 or less are suppressed.
Age-specific rate:
A rate of an event (such as disease or death) measured within a particular age group. It is similar to a crude rate but is calculated within an age group (e.g. an age-specific rate of oral health hospitalizations in adults 35-44 years of age).
To protect an individual's privacy, rates based on counts of 5 or less are suppressed.
Limitations of Iowa Hospitalization and Emergency Department Visit Data
Multiple hospitalizations or emergency department visits by the same patient cannot be identified and are not excluded.
These data are not appropriate for estimating the total burden of oral health problems.
Iowa residents discharged from hospitals in surrounding states are not included, so hospitalization and emergency department visit rates for counties in which residents are likely to receive care in a surrounding state may be underestimated. Rates for counties in which residents are likely to visit hospitals that do not submit data to the Iowa Hospital Association (e.g., Veteran's Administration, Indian Health Services hospitals, and institutionalized populations) may also be artificially low.
There is usually a two-year lag period before hospitalization and emergency department visit data are available.
Limitations of Child Dental Services (Medicaid) Data
Multiple services by the same patient across provider types cannot be identified and are not excluded, though a patient is only counted once in each provider type.
These data are not appropriate for estimating the total burden of oral health problems.
These measures use Federal Fiscal Year dates whereas other Iowa Medicaid and oral health measures use State Fiscal Year (July–June), Calendar Year (January–December) or at times, Grant Year (dependent on the grant).
There is usually a six-month lag period before Child (0-20) Dental Services data are available.
