Date of Award

Fall 2015

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Deanne Shuman

Committee Member

Hind Baydoun

Committee Member

Susan Daniel


The purpose of this study was to clarify the relationship between diabetes and dental service use. This study addressed the question of whether individuals with diabetes are more or less likely to utilize dental services, measured in terms of preventive and emergency services during the past year. A cross-sectional study was conducted to assess the contributions of diabetes status to dental service use, relative to the contributions of Andersen and Newman Framework of Health Services Utilization dimensions (predisposing, enabling, and illness variables) in predicting dental service utilization during the past year using a nationally representative sample from a 2001-2002 National Health and Nutrition Examination Survey (NHANES) dataset. A stratified multistage design was used to obtain a representative probability sample. A series of selection criteria was applied to comply with the purpose of the study. The target population of this study was U.S. civilian, non-institutionalized adults, who were 18 years of age or older. A total of 11,039 subjects participated in the 2001-2002 NHANES. Of those, 4,707 were eligible to participate in the study based on the inclusion and exclusion criteria. The appropriate procedures in Statistical Analysis Software (SAS®) were utilized to accommodate the NHANES sampling design and weights. The data analysis using Chi-Square Test reveals that individuals with diabetes (3%) were significantly (p=0.0002) less likely to utilize dental services in the past 12 months compared to individuals without diabetes (67%). Significant predictors in preventive service utilization model were: gender (OR=1.38, 95% CI: 1.16, 1.65), marital status (OR=0.72, 95% CI:0.56,0.91), age (OR=0.63,95% CI:0.45,0.88), education (OR=2.0, 95% CI:1.53,2.63), income (OR=5.21, 95% CI:1.69,15.98), regular source of care (OR=15.8, 95% CI:11.95, 20.91), dental insurance (OR = 1.53, 95% CI:1.15,2.04), self-reported pain (OR=0.75, 95% CI:0.56,0.99), and recommended care based upon oral exam findings (OR=0.30, 95% CI:0.23,0.41). Diabetics were less likely to obtain preventive service use than non-diabetics (OR=0.60, 95% CI: 0.40, 0.92). Significant predictors in emergency service utilization model were: unmarried status (OR=0.72, 95% CI: 0.54, 0.94), age (OR=0.63, 95% CI: 0.44, 0.89), education (OR=1.53, 95% CI: 1.13, 2.06), regular source of care (OR=6.7, 95% CI:4.77, 9.44), dental insurance (OR= 1.9, 95% CI:1.36, 2.65), self-reported painful tooth (OR=2.02, 95% CI:1.60, 2.57), and recommended care based upon oral exam findings (OR=0.72, 95% CI:0.54, 0.97). The results of this study indicate that diabetes status is a significant predictor of not having a preventive dental visit, even after controlling for age, gender, marital status, income, race/ethnicity, and education. This finding is a reason for concern due to the fact that the literature is full of studies showing the effect of diabetes on oral health and the effect of periodontitis on glycemic control among individuals with diabetes. Therefore, a regular dental visit for individuals with diabetes is necessary. Understanding the relationship between diabetes and periodontal diseases is important for individuals with diabetes to reduce oral complications, improve quality of life, and improve health outcomes. Integrating oral health with diabetes management care helps in clarifying this association.