About Oral Health Data

Reporting oral health-related hospitalizations and emergency department visits, as well as dental services provided to at-risk populations helps Iowans better understand who is receiving preventive care, those with serious dental problems, and the populations most in need of assistance to access care.

This page provides general information about oral health data and measures developed by the Iowa Public Health Tracking program. Contact us for more information about these data.

What do these data tell us?

Iowa Hospitalization and Emergency Department Visit Data tells us:

The numbers and rates of oral health hospitalizations and emergency department visits in Iowa by year, age group and gender.
If the numbers and rates of oral health hospitalizations and emergency department visits are going up or down over time.
If a segment of a population is at higher risk for hospitalization or a visit to the emergency department due to oral health problems.

Child Dental Services (Medicaid) data tells us:

The numbers and rates of Medicaid-reimbursed dental services for children ages 0-20 in Iowa by year, age group and county.
If services by a provider type are going up or down over time.
If a segment of the Medicaid-enrolled children ages 0-20 population is less likely to visit a dentist or get routine preventive dental care within a year.

How can we use this data?

To inform the public about hospitalizations and emergency department visits for dental issues.
To inform the public about Medicaid-enrolled children’s access to dental services.
For program planning and evaluation by state and local partners.

What can these data not tell us?

Iowa Hospitalization and Emergency Department Visit Data does NOT tell us:

What causes oral health problems, or what leads to oral health hospitalizations and emergency department visits.
The total burden of oral health problems in a population.
The number of people who are hospitalized or who visited an emergency department for an oral health problem. Because personal identifiers are removed from the hospital discharge data before analysis, individuals who have multiple hospitalizations or emergency department visits cannot be identified.

Child Dental Services (Medicaid) data does NOT tell us:

The specific type of services received by Medicaid-enrolled Iowa children.
The provider of the service (medical or dental professional).

What is the source of the data?

Hospitalization and emergency department data are collected by the Iowa Hospital Association on behalf of Iowa HHS in accordance with Iowa Code section 135.166.
Bridged-race population estimates from the National Center for Health Statistics and US Census. Data from 2000 to 2009 are based on intercensal population estimates and 2010-most current year are based on the postcensal population estimates.
Child Dental Services (Medicaid) data are collected by Iowa Medicaid Enterprise (IME), submitted to the Center for Medicaid and Medicare Services (CMS), and reported to IDPH via IME per their interagency agreement.

What time period of data is available?

The Iowa Public Health Tracking portal displays hospitalization data from the year 2000 through the most recent year of data available.
The Iowa Public Health Tracking portal displays Emergency Department visit data from the year 2003 through the most recent year of data available.
There is usually a two-year lag period before hospitalization and emergency department visit data are available.
The Iowa Public Health Tracking portal displays Child Dental Services (Medicaid) data from the year 2010 through the most recent year of data available.
Child Dental Services (Medicaid) data is presented in Federal Fiscal Year (ex. “2017” runs October 1, 2016 - September 30, 2017).
There is usually a six-month lag period before Child Dental Services (Medicaid) data are available.

How are oral health hospitalizations and emergency department visits identified?

Hospitalizations are defined as Iowa residents who are discharged from a hospital in Iowa.
Emergency Department visits are defined as Iowa residents who are treated and released or subsequently admitted to a hospital in Iowa.
Oral health hospitalizations have a primary discharge diagnosis of an oral health problem.
Oral health emergency department visits have an oral health problem as the first-listed diagnosis.
Oral health problems are defined as the International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) codes that begin with 520-528.
Oral health problems are defined as the International Classification of Disease 10th Revision, Clinical Modification (ICD-10-CM) codes that begin with K00-K13, M26, or M27.

How are ‘any dental service’, ‘oral health service by non-dentist’, and ‘any dental or oral health service’ defined?

‘Any dental service’ is defined as a service with a Medicaid-reimbursed dental code between 00100-09999 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC), or from a Title V screening center or maternal health center (public health organization having a contract with IDPH for local child or maternal health services).
‘Preventive dental service’ is defined as a service with a Medicaid-reimbursed dental code between 1000-1999 provided in a dental office or clinic, a Federally Qualified Health Center (FQHC), or from a Title V screening center or maternal health center.
Dental Treatment Services is defined as services with a Medicaid-reimbursed dental code between 2000-9999 provided in a dental office or clinic or a Federally Qualified Health Center (FQHC).
Sealant on a Permanent Molar Tooth is defined as a service with a Medicaid-reimbursed dental code of 1351 provided to children ages 6-14 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC), or from a Title V screening center or maternal health center.
Diagnostic Dental Services is defined as services with a Medicaid-reimbursed dental code between 0100-0999 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC), or from a Title V screening center or maternal health center.
‘An oral health service by a medical professional’ is defined as a service with a Medicaid-reimbursed dental code between 00100-01999 or CPT code 99188 and provided in a medical office or by nurses working in a Title V screening center or maternal health center (public health organizations having a contract with IDPH for local child or maternal health services).
‘Any dental or oral health service’ is defined as a service with a Medicaid-reimbursed dental code between 00100-09999, or CPT code 99188 and provided in a dental office or clinic, a Federally Qualified Health Center (FQHC), a medical office, or from a Title V screening center or maternal health center.

NOTE: Prior to 2013, services provided by dental hygienists working in Title V screening centers or maternal health centers were captured as “oral health services by a medical professional” and caution should be taken if comparing 2012 and earlier to 2013 and later.

What is the difference between a number, rate, age-adjusted rate, and age-specific rate? How would I use them?

Number:

If you want to understand the magnitude or how big the overall burden is, then use the number.
The number indicates the total number of hospitalizations or emergency department visits due to an oral health problem, but not the number of unique individuals hospitalized or who visited the emergency department.
To protect an individual's privacy, counts of 5 or less are suppressed.

Crude Rate:

If you want to understand the probability or what is the underlying risk in a population, then use a rate.
In our analysis a rate is calculated using a numerator, the number of oral health hospitalizations during a period of time, divided by a denominator, the number of people in a population during the same period of time. This fraction is then multiplied by 10,000 to provide a more recognizable value.
To protect an individual's privacy, rates based on counts of 5 or less are suppressed.

Age-adjusted rate:

Age-adjusted rates are useful when comparing the rates of two population groups that have different age distributions.
A weighted average, called the direct method, is used to adjust for age in this analysis. Age specific rates in a given population are adjusted to the age distribution in a standard population by applying weight. The U.S. 2000 Standard population is used as the basis for weight calculations.
To protect an individual's privacy, rates based on counts of 5 or less are suppressed.

Age-specific rate:

A rate of an event (such as disease or death) measured within a particular age group. It is similar to a crude rate but is calculated within an age group (e.g. an age-specific rate of oral health hospitalizations in adults 35-44 years of age).
To protect an individual's privacy, rates based on counts of 5 or less are suppressed.

What are the limitations of the data?

Iowa Hospitalization and Emergency Department Visit data:

Multiple hospitalizations or emergency department visits by the same patient cannot be identified, and are not excluded.
These data are not appropriate for estimating the total burden of oral health problems.
Iowa residents discharged from hospitals in surrounding states are not included, so hospitalization and emergency department visit rates for counties in which residents are likely to receive care in a surrounding state may be underestimated. Rates for counties in which residents are likely to visit hospitals that do not submit data to the Iowa Hospital Association (e.g., Veteran's Administration, Indian Health Services hospitals, and institutionalized populations) may also be artificially low.
There is usually a two-year lag period before hospitalization and emergency department visit data are available.

Child Dental Services (Medicaid) data:

Multiple services by the same patient across provider types cannot be identified and are not excluded, though a patient is only counted once in each provider type.
These data are not appropriate for estimating the total burden of oral health problems.
These measures use Federal Fiscal Year dates whereas other Iowa Medicaid and oral health measures use State Fiscal Year (July-June), Calendar Year (January-December), or at times, Grant Year (dependant on the grant).
There is usually a six-month lag period before Children (0-20) Dental Services data are available.

Where can I find more technical information about the data?

More detailed documentation of the oral health hospitalization and emergency department visit data can be found in the following documents:

Indicator Profiles

Oral Health Emergency Department Visits
Oral Health Hospitalizations