Title: 0145 - Oral Health and Dental Utilization Differs by Rurality in Appalachia


Yuqiao Zhou (Presenter)
University of Pittsburgh

Rich Cuddy, University of Pittsburgh
Daniel McNeil, West Virginia University
Casey Wright, West Virginia University
Deborah Polk, University of Pittsburgh
Richard Crout, West Virginia University School of Dentistry
Robert Weyant, University of Pittsburgh
Eleanor Feingold, University of Pittsburgh
Katherine Neiswanger, University of Pittsburgh
Mary Marazita, University of Pittsburgh
John Shaffer, University of Pittsburgh


Objectives: This study determined how rurality covaried with access to dental care, oral health behaviors, and oral health status among adults living in northern Appalachia.

Methods: Participants were Appalachian resident adults aged 18-59 (n=1089) from the Center for Oral Health Research in Appalachia (COHRA). Rural-Urban Continuum codes corresponding to the GPS coordinates of participants’ residences were used to classify participants as metropolitan or nonmetropolitan (i.e., small town and rural). Logistic and linear regression were used to estimate the association of rurality with measures of oral health status, dental care utilization, oral health related behaviors. Models were adjusted for socio-demographics variables such as age, sex, race, income, and dental insurance.

Results: Nonmetropolitan residents exhibited fewer sound teeth (β=-1.71, p<0.001), more white-spot carious lesions (β=0.65, p<0.0005), higher rates of gingival recession (OR=4.0, p<10-12), and higher rates of complete edentulism (OR=2.8, p=0.017). Likewise, differences in dental care utilization behaviors were observed between nonmetropolitan and metropolitan residents for 8 of 9 utilization measures tested (all p<0.0005). For example, nonmetropolitan residents were less likely to go to dentist for routine checkups (OR=0.4, p<0.00001) and were more prone to seek care only after experiencing a dental problem (OR=2.2, p<0.00001). These differences were not explained by socio-demographic variables. However, nonmetropolitan residents were more likely to report “costs too high” (OR=6.0, p<10-12) as a major reason for not utilizing dental care services. The oral health related behaviors of brushing, flossing, and using mouthwash did not differ significantly by rurality.

Conclusions: After adjusting for socio-demographic variables, nonmetropolitan resident adults in Northern Appalachia were found to differ significantly from metropolitan resident adults with respect to their oral health status and utilization of dental services. This finding suggests that rurality is associated with risks to oral health that may need to be explicitly addressed through targeted disparity reduction interventions.

Student Presenter

This abstract is based on research that was funded entirely or partially by an outside source:
NIH NIDCR grant R01-DE014899

Disclosure Statement:
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: None

Sponsoring Group/Network