Background: Oral health is an essential component of general health and well-being, yet barriers to the access of dental care and unmet needs are pronounced, particularly in rural areas. Despite associations with systemic health, few studies have assessed unmet dental needs across the lifespan as they present in primary care. This study describes the prevalence of oral health conditions and unmet dental needs among patients presenting for routine care in a rural Oregon family medicine practice.Methods: Eight primary care clinicians were trained to conduct basic oral health screenings for 7 dental conditions associated with International Statistical Classification of Diseases and Related Health Problems 9 -Clinical Modification codes. During the 6-week study period, patients older than 12 months of age who presented to the practice for a regularly scheduled appointment received the screening and completed a brief dental access survey.Results: Of 1655 eligible patients, 40.7% (n ‫؍‬ 674) received the screening and 66.9% (n ‫؍‬ 1108) completed the survey. Half of the patients who were screened (46.0%, n ‫؍‬ 310) had oral health conditions detected, including partial edentulism (24.5%), dental caries (12.9%), complete edentulism (9.9%), and cracked teeth (8.9%). Twenty-eight percent of the patients reported experiencing unmet dental needs. Patients with dental insurance were significantly more likely to report better oral and general health outcomes as compared with those who had no insurance or health insurance only.Conclusions: Oral health diseases and unmet dental needs presented substantially in patients with ages ranging across the lifespan from one rural primary care practice. Primary care settings may present opportune environments for reaching patients who are unable to obtain regular dental care.

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The objective of the paper is to introduce a copula methodology of economic capital modeling, which is practically applicable for life insurance companies. Copula methods make it possible to address multiple dependent risk factors including both investment and underwriting risks in the framework of a portfolio approach. We identify a relevant set of asset and liability variables, and suggest a copula model for the joint distribution of these variables. Estimates of economic capital are constructed via VaR and TVaR calculations based on the tails of this joint distribution. This approach requires ARIMA and copula model selection followed by Monte Carlo simulation of the time series of the joint asset/liability portfolio. Models are implemented in open source software (R and MS Excel) and tested using historical and simulated asset/liability data. The results are applied to the construction of a software tool which can be utilized for customization and direct user application. The novelty of the approach consists in estimating interdependent underwriting and investment risks in one multivariate model taking into account short-term (daily or monthly) fluctuations of the market. In particular, we address the challenges that life insurance companies face in the low interest environment, using the market data for the 15-year period 2003-2018.

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