Background: 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).
Methods: 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.
Results: 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
Conclusions: We found significant geographic variation in dental procedures received by children enrolled in