Our exploratory study examined rural-urban differences in dental care utilization during early childhood among Medicaid-enrolled children aged younger than 4 years in South Carolina. We conducted a secondary data analysis using Medicaid data. Dependent variables included preventive dental visits, use of medical settings (emergency room [ER] and primary care [PC] offices) for dental reasons, receipt of fluoride varnish, and dental home status. The primary independent variable was child's area of residence, rural or urban. The control variables were child's age, gender, race, and special healthcare need status. In adjusted analyses, rural children were found to have significantly higher odds of lacking preventive dental visits, fluoride varnishes, and dental homes as well as using medical settings for dental reasons compared to urban children. This difference, however, was not a simple function of rural residence. Other variables such as race and special healthcare need status interacted with rurality in explaining the differences in the outcomes of interest except visiting medical settings for dental reasons. Children under age of 2 years had higher odds of undesirable outcomes compared to those aged older than 2 years. Significant disparities in dental care utilization were evident among rural, Medicaid-enrolled preschool-aged children in South Carolina. While the state has addressed Medicaid reimbursement and related policies for nearly 10 years, their impact may be disproportionately effective.

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Objectives: Previously published sealant measures are not useful when applied to Medicaid claims data in states where dental services are carved out of managed care. A novel sealant measure was developed to assess the degree to which dental providers seal eligible teeth during preventive dental visits (PDVs) in an effort to ascertain if such a measure can be used to valuate provider performance, as condition of potential value-based care model implementation. Methods: A single-county feasibility study was conducted using Medicaid claims. A study cohort included children aged 8 years and enrolled 12 months during 2018. Prospective analysis was used to determine whether dental sealants were applied by the same dentists during PDVs or up to 9 months thereafter. Eligible teeth included first permanent molars. Teeth previously restored, sealed or missing were excluded. PDV was defined as any encounter with prophylaxis, fluoride treatment, or EPSDT. Claims were compared to public health surveillance for measurement validation. Results: Single-county results showed 11 percent of eligible teeth were sealed. Only 9 percent of dentists applied sealants to at least 40 percent of eligible teeth. Face validation of sealant rate was 23 percent Medicaid versus 36 percent Public Health. The former measures incidence and the latter prevalence with greater heterogeneity that included partially retained sealants. Conclusions: A sealant measure that assesses provider adherence to sealant standards of care was produced. It has potential application for assessing performance of pediatric preventive services and informing value-based performance expectations.

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