Graduation Date

Summer 8-11-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

David Palm

MeSH Headings

Dental Care, Adults, Dental Health Services, Diabetes Mellitus* / epidemiology, Sick Leave, United States, Emigrants and Immigrants


Given the importance of oral health in maintaining the general health and well-being of an individual, this dissertation includes three independent studies examining dental care utilization and expenditures among adults in the U.S. The first study examines the effectiveness of preventive dental visits on treatment utilization and expenditures among adults aged 18 and above. The second study focuses on the impact of paid sick leave on different types of dental services utilization among working adults aged 18-64. Finally, the last paper compares the differences in dental care utilization and related expenditure between foreign-born and US-born adults with diabetes. The paper also estimates the percentage of diabetes adults with a past-year medical visit and no dental visit based on immigration status and health-related variables. The analyses in this research utilize data from the Medical Expenditure Panel Survey.

The dissertation shows the following: 1) a significant association between the previous year's preventive dental visits and an increase in the use of subsequent treatment services and related treatment expenditures, primarily due to restorative dental procedures, as observed using a two-year panel study; 2) an increase in the utilization of preventive and diagnostic dental services among working adults aged 18-64 years with access to paid sick leave, as indicated by the data from 2019; and 3) lower utilization of dental services and related expenditures among foreign-born adults with diabetes compared to their US-born counterparts, based on pooled data from two years (2018-2019). The study shows a high percentage of adults who had a medical visit for diabetes but not a dental visit.

The findings underscore the significance of regular preventive dental services in the early identification and treatment of oral problems, thus reducing costly and invasive procedures. Additionally, the dissertation underlines the necessity of implementing paid sick leave policies and fostering supportive workplace environments. It also stresses the importance of improving dental-medical integration and employing targeted approaches to increase access to dental care services among vulnerable populations, including foreign-born adults with diabetes and working adults without paid sick leave benefits at the workplace.


2023 Copyright, the authors

Available for download on Thursday, July 31, 2025