The influence of the COVID-19 public health emergency and dental coverage on the utilization of endodontic treatment in the United States

Objectives: This study aims to examine the impact of the COVID-19 public health emergency on state-level dental service utilization, focusing on endodontic care; and to understand how benefit design and coverage influence healthcare disparities in oral health. Methods: The data comes from the 2019-2021 Centers for Medicare & Medicaid Services (CMS) unredacted Transformed Medicaid Statistical Information System (T-MSIS). State-level coverage was collected from state Medicaid program provider manuals. We analyzed service utilization rates overall and by demographic factors such as age, sex, and race/ethnicity. Chi-square tests were used to test for significant differences in the rates across the years and within each group. Clustered-robust standard error models were used to predict the odds of receiving an endodontic service. Results: The COVID-19 pandemic significantly disrupted dental service utilization across the United States, with a marked decrease in preventive and routine dental care. Utilization of endodontic services experienced less of a decline during the pandemic and a significant increase post-pandemic, compared to other dental services. States with more comprehensive Medicaid dental benefits design had significantly higher rates of endodontic service utilization for children and adults. Among children, increased age, female gender, and non-Hispanic Black race/ ethnicity were significantly associated with lower levels of endodontic service utilization. Among adults, rural residence designation was significantly associated with lower levels of endodontic service utilization. Conclusion: The study highlights the critical role of benefit design in ensuring dental service utilization, particularly during public health emergencies. Oral health stakeholders must recognize the potential long-term consequences of delayed dental care and remain innovative in providing care under limited circumstances.