Trends in dental care utilization and tooth loss among vulnerable adults in Nevada (2018-2024): a repeated cross-sectional analysis in the context of COVID-19 and medicaid coverage expansions.

BACKGROUND

Oral health disparities persist among adults with chronic conditions and structural barriers to care, including diabetes, disability, and residence in non-metropolitan areas. Recent Medicaid expansions in Nevada and COVID-19-related disruptions to dental service delivery provide important context for examining population-level trends in oral health care utilization and outcomes.

METHODS

We used repeated cross-sectional data from the Nevada Behavioral Risk Factor Surveillance System (BRFSS) for 2018, 2020, 2022, and 2024 (N = 11,552) to examine trends in past-year dental visits and permanent tooth loss among adults aged ≥ 18 years. Survey-weighted logistic regression models were used to estimate adjusted prevalence by year and to assess associations with area of residence, diabetes, and disability status, adjusting for age, sex, race/ethnicity, income, smoking status, and insurance coverage.

RESULTS

The prevalence of past-year dental visits declined from 67.1% in 2018 to 63.5% in 2024 (AOR:0.84, 95% CI: 0.74-0.95). In 2018, adults with diabetes had lower utilization than those without diabetes (53.9% vs. 69.0%), a difference that was attenuated in subsequent years (2020, 2022, and 2024). Adults with disabilities (vs. no disabilities) consistently had lower utilization in both 2018 (58.3% vs. 71.5%) and 2024 (57.9% vs. 67.3%). Metropolitan residents had higher utilization than non-metropolitan residents in 2018 (68.5% vs. 62.7%) and 2024 (66.1% vs. 56.1%). The prevalence of permanent tooth loss increased from 45.8% in 2018 to 49.0% in 2022 (AOR:1.17, 95% CI: 1.04-1.31). Permanent tooth loss was higher in all years for adults with diabetes, disability, and residing in non-metropolitan counties.

CONCLUSIONS

Between 2018 and 2024, dental service utilization in Nevada declined following the COVID-19 pandemic and did not fully rebound, while disparities by disability, diabetes, and geographic residence persisted. These findings highlight the need for integrated strategies that address both coverage and structural barriers to improve oral health equity in Nevada.