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Oral Health Epidemiology and Policy in Disadvantaged Populations

Khouja, Tumader (2020) Oral Health Epidemiology and Policy in Disadvantaged Populations. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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This dissertation seeks to study important questions regarding oral health epidemiology and policy affecting oral health care access and outcomes in disadvantaged populations.

Chapter one introduces the research problems.
Chapter two evaluates the relationship between oral health measures and systemic disease. Little is known about the role periodontal disease plays in the development of cardiovascular complications in type 1 diabetes. Using data from a longitudinal cohort of patients with type 1 diabetes, we evaluate the association between periodontal disease and cardiovascular complications and mortality. We find that periodontal disease increases the risk of cardiovascular complications, but not mortality, among type 1 diabetes patients who smoke.

Chapter two examines the association between dental policies for adults in Medicaid and children’s receipt of preventive dental services. Although prior research has found “spillover effect” between adults Medicaid coverage and children’s use of preventive medical visits, this relationship has not been studied in dentistry. We use 14 years of nationally representative survey data to link parents and their children and run two quasi-experimental analyses. We evaluate the effect of changes in dental benefits for adults in Medicaid and the effect of Medicaid expansions for adults under the Affordable Care Act on children’s use of preventive dental services. We find no evidence of a “spillover” effect between adult dental policies and children’s receipt of preventive dental services.

Chapter three evaluates the problem of excess opioid prescribing for dental procedures. We evaluate the risk of an initial opioid fill and subsequent opioid fills based on the likelihood of pain associated with the dental procedure among opioid naïve PA Medicaid beneficiaries. Using Medicaid claims data from 2012-2017, we find that patients who filled an opioid for procedures with low likelihood of pain were more likely to use opioids in the short term compared to those who did not fill an opioid for the same procedures and compared to patients with an initial opioid for procedures with moderate and high likelihood of pain.

This dissertation has important implications for public health. Our findings provide evidence for health system interventions to: 1) improve the integration of oral health with systemic health for patients with type 1 diabetes. 2) The need for policy interventions that have a more direct impact on improving low-income children’s use of preventive dental services. 3) Emphasizing NSAID as a first line of therapy for management of dental pain and re-evaluating the current guidelines for opioid prescribing in the dental practice.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Khouja, Tumadertuk4@pitt.edutuk40000-0001-6042-4866
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDonohue,
Committee Membercostacou,
Committee MemberYabes,
Committee MemberMoore,
Committee MemberWeyant,
Date: 30 July 2020
Date Type: Publication
Defense Date: 8 October 2019
Approval Date: 30 July 2020
Submission Date: 8 June 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 144
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Services Administration
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: oral health, oral health policy, epidemiology
Date Deposited: 31 Jul 2020 03:08
Last Modified: 01 Jul 2022 05:16


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