This cross-sectional, non-experimental study evaluates associations between cohort membership, type of dental coverage, and utilization of dental services in all patients age 47 and over who received dental care at Virginia Commonwealth University’s (VCU) School of Dentistry in 2011. Structural Lag Theory poses that society’s institutions lag behind the actuality of a healthy and capable older adult population. The two dynamisms of the Structural Lag Theory were used for this study. The Dynamism of Changing Lives is represented by Cohort differences. Cohort differences include cohort size, people living longer and retaining more of their natural teeth along with different attitudes toward dental care. This dynamism impacts the Dynamism of Structural Change, represented by the institutions of dental coverage and utilization of dental services. Cohort membership is an independent variable. The dependent variable, utilization, is defined as Financial-Total amount spent and Procedural-Routine adult dental prophylaxis. Dental coverage, a dichotomous variable, is used as an independent and dependent variable. Descriptive statistics revealed employer provided dental coverage is the most prevalent type of dental coverage. However, when considered a payment source, out of pocket funding is the primary source of payment for dental services. Using Chi-square and logistic regression, examination of Cohorts (1-Greatest Generation, 2-Silent Generation, 3-Baby Boomer Generation) revealed that Cohort 2 had more dental coverage than Cohort 1, and Cohort 3 had more dental coverage than Cohort 2. Using logistic regression, Cohort 2 showed the highest level of Procedural utilization. Evaluating Financial utilization, multiple regression models showed Cohort 1 utilized more than Cohort 2 and Cohort 2 utilized more than Cohort 3. Those with dental coverage spend more on dental services, fees for routine adult dental prophylaxis make up the majority of the total amount spent, and those with dental coverage utilize more dental services when defined as total amount spent. Because they have experienced different social, political, economic, and technological changes at different times in their life course, the receipt of dental services by new cohorts of older people differs from previous ones. Findings from this study confirm that there is a structural lag in Medicare policy and its coverage of dental services.

One of the most important factors in accessing dental care is having dental insurance. For people with low incomes, Medicaid is the main source of health insurance. Medi-Cal is California’s Medicaid program. Adult dental services were mostly eliminated in Medi-Cal in 2009 due to the economic downturn and partially restored in 2014. The objective of this study is to evaluate the effect of change in Medi-Cal dental coverage, specifically the partial restoration of adult dental coverage in 2014, on dental care utilization among Medi-Cal beneficiaries. The partial restoration significantly increased the utilization rates in dental clinics from 2014 to 2017 (22% in 2017 vs. 12% in 2013) for the overall population. However, the magnitude of increase differs in different age groups and ethnic groups. More statistically significant findings show greater utilization rates among beneficiaries of 19-64 than 65-74 and 75+ years old. Also, more significant findings show lower utilization among Black than White, Hispanic or Asian beneficiaries. The partial restoration significantly reduced the dental related ER visits among Medi-Cal beneficiaries from 2015 to 2017. However, the reduction is largely seen in beneficiaries of 19-64 years old in the ethnic groups of White and Black with reductions of 20 and 15 visits per 1,000 enrollees respectively in 2017 comparing to 2013. The dental related ER visits were lower for Hispanics and Asians, and remained very low among those 65 years old and above. In addition, the partial restoration resulted in increases in participation of dental care providers in the Medi-Cal program.