Open Access Open Badges Research article

Rural–urban differences in dental service use among children enrolled in a private dental insurance plan in Wisconsin: analysis of administrative data

Pradeep Bhagavatula1*, Qun Xiang2, Aniko Szabo2, Fredrick Eichmiller3, Raymond A Kuthy4 and Christopher E Okunseri1

Author Affiliations

1 Department of Clinical Services, Marquette University School of Dentistry, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA

2 Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, USA

3 Delta Dental of Wisconsin, Milwaukee, USA

4 Department of Preventive and Community, Dentistry University of Iowa College of Dentistry, Milwaukee, USA

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BMC Oral Health 2012, 12:58  doi:10.1186/1472-6831-12-58

Published: 21 December 2012



Studies on rural–urban differences in dental care have primarily focused on differences in utilization rates and preventive dental services. Little is known about rural–urban differences in the use of wider range of dental procedures. This study examined patterns of preventive, restorative, endodontic, and extraction procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI).


We analyzed DDWI enrollment and claims data for children aged 0-18 years from 2002 to 2008. We modified and used a rural and urban classification based on ZIP codes developed by the Wisconsin Area Health Education Center (AHEC). We categorized the ZIP codes into 6 AHEC categories (3 rural and 3 urban). Descriptive and multivariable analysis using generalized linear mixed models (GLMM) were used to examine the patterns of dental procedures provided to children. Tukey-Kramer adjustment was used to control for multiple comparisons.


Approximately, 50%, 67% and 68 % of enrollees in inner-city Milwaukee, Rural 1 (less than 2500 people), and suburban-Milwaukee had at least one annual dental visit, respectively. Children in inner city-Milwaukee had the lowest utilization rates for all procedures examined, except for endodontic procedures. Compared to children from inner-city Milwaukee, children in other locations had significantly more preventive procedures. Children in Rural 1-ZIP codes had more restorative, endodontic and extraction procedures, compared to children from all other regions.


We found significant geographic variation in dental procedures received by children enrolled in DDWI.

Oral health; Urban; Rural; Dental care for children; Dental Insurance; Health services accessibility