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.

Even though the oral health of Americans has improved greatly in the last 50 years, some specific groups of the population have been left behind. Latinos, children and adults, bear a disproportionate burden of oral diseases. Latino children, the fastest growing minority group of children in the US, are affected disproportionately by oral diseases like dental caries compared to other groups. Understanding the difficulties and barriers that these children have to utilize dental care will help us in the future to develop effective programs to reduce health disparities in this segment of the population. The purpose of this study is to identify the factors that determine dental services access and utilization by children in the state of Iowa. Emphasis will be given to differences in utilization of dental services among different racial/ethnic groups. Additionally, the study will describe and compare difficulties in utilization of care among Latino children whose parents answered the survey in English (LE) and those who answered it in Spanish (LS). In order to address these objectives existing data from the Iowa Child and Family Household Health Survey 2005 (HHS) were analyzed. The dependent variable for the study was utilization of dental services. This outcome variable was dichotomized as whether or not the child had a dental visit in the last year. Characteristics of study subjects were first analyzed through descriptive statistics. Bivariate analyses were conducted to assess associations between the dependent variable and independent variables. Multiple logistic regression was used to identify factors associated with utilization of dental services in Iowa's children, and for each different racial and ethnic group. Seven factors were related to the time of the last dental visit for Iowa children: Having a regular source of dental care, dental insurance status, having a dental need in the past 12 months, brushing habits, the age of the children, and family income. The same seven factors were correlated to having a dental visit for white children. For African-American children, having a regular source of dental care, dental insurance status, and having a dental need in the last 12 months were the factors that were found associated to the time of the last dental check-up. For the Latino Spanish children, having a regular source of dental care and the age of the children were factors associated to dental utilization. Finally, for the Latino English children, the only factor associated with having a dental visit was having a regular source of dental care. Information from this research gives policy makers, public health workers, and clinicians an overview of oral health disparities affecting children in the state. For those agencies in Iowa interested in the improvement of access and utilization of dental services for minority children, this project gives important inside about the factors related to the use of services for different racial/ethnic groups in the state.