Relationship Between Medical Well Baby Visits and First Dental Examinations for Young Children in Medicaid

Donald, L.; Momany, Elizabeth T.; Jones, Michael P.; Kuthy, Raymond A.; Askelson, Natoshia M.; Wehby, George L.; Damiano, Peter C.

doi:10.2105/ajph.2012.300899

Cited by 24 publications

(27 citation statements)

References 38 publications

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“…One article by Savage et al 12 involving Medicaidenrolled children in North Carolina has been described as providing "seminal" evidence of the effectiveness and costeffectiveness of early preventive dental care, 13 was used in a policy brief on early preventive dental care promoted by the Centers for Disease Control and Prevention, 10 and continues to be cited as evidence of cost-effectiveness of pediatric preventive dental care in public insurance programs. 14 However, that study actually found that children in the sample who received their first preventive visit before the age of 1 year (23 of 9204) showed no statistical difference in subsequent dental outcomes compared with the rest of the sample. Children who received their first preventive visit between ages 1and 2 years, or between ages 2 and 3 years, had significantly higher use of restorative and emergency dental services compared with children who had their first preventive visit at age 3 years or later.…”

Section: Discussionmentioning

confidence: 91%

Effectiveness of Preventive Dental Visits in Reducing Nonpreventive Dental Visits and Expenditures

et al. 2013

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BACKGROUND AND OBJECTIVE: Although preventive dental visits are considered important for maintaining pediatric oral health, there is relatively little research showing that they reduce subsequent nonpreventive dental visits or costs. At least 1 study seemed to find that early preventive dental care is associated with more restorative and emergency visits. Previous studies are limited by their inability to account for unmeasurable factors that may lead children to “select” into using both more preventive and nonpreventive dental care. We used econometric techniques that minimize selection bias to assess the effectiveness of preventive dental care in reducing subsequent nonpreventive dental service utilization among children. METHODS: Using data from Alabama’s Children’s Health Insurance Program (CHIP), 1998–2010., a cohort study of children’s dental service utilization was conducted. Outcomes were 1-year lagged nonpreventive dental care and expenditures, and overall dental and medical expenditures. Children who were continuously enrolled for at least 3 years were included. Separate models were estimated for children aged <8 years (n = 14 972) and those aged ≥8 years (n = 21 833). RESULTS: More preventive visits were associated with fewer subsequent nonpreventive dental visits and lower nonpreventive dental expenditures for both groups. However, more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures. CONCLUSIONS: Preventive dental visits can reduce subsequent nonpreventive visits and expenditures for children continuously enrolled in CHIP. However, they may not reduce overall program costs. Effective empirical research in this area must continue to address unobserved confounders and selection issues.

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Section: Discussionmentioning

confidence: 91%

Effectiveness of Preventive Dental Visits in Reducing Nonpreventive Dental Visits and Expenditures

et al. 2013

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“…To facilitate early preventive dental visits for preschool-aged children enrolled in Medicaid, Askelson et al 46 described the introduction of a research framework among caregivers. In a recent study, Chi et al 47 highlighted the close association between well-child visits and first dental examinations among young Medicaideligible children, emphasizing the public health potential for using this avenue to improve children' s oral health. Emerging cost-effectiveness data provide additional support for interdisciplinary collaborations of dentistry with family medicine and pediatrics for screening and possible referral of children at high risk.…”

Section: Discussionmentioning

confidence: 99%

Influence of Caregivers and Children’s Entry Into the Dental Care System

Divaris¹,

Lee²,

Baker³

et al. 2014

Pediatrics

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OBJECTIVES: Early preventive dental visits are essential in improving children’s oral health, especially young children at high risk for dental caries. However, there is scant information on how these children enter the dental care system. Our objectives were as follows: (1) to describe how a population-based cohort of young Medicaid-enrolled children entered dental care; and (2) to investigate the influence of caregiver characteristics on their children’s dental care–seeking patterns. METHODS: We relied on Medicaid claims and interview data of caregiver–child dyads who were enrolled in the Carolina Oral Health Literacy study during 2007–2008. The analytical cohort comprised 1000 children who had no dental visits before enrollment. Additional information was collected on sociodemographic characteristics, oral health status, health literacy, dental neglect, and access to care barriers. Our analyses relied on descriptive, bivariate, and multivariate methods. RESULTS: During the 25-month median follow-up period, 39% of the children (mean baseline age: 16 months) entered the dental care system, and 13% of their first encounters were for emergency care. Caregivers’ dental neglect emerged as a significant predictor of nonentrance. Children with reported oral health problems at baseline were more likely to enter the dental care system compared with children with better oral health, but they were also more likely to require emergency care. CONCLUSIONS: Caregivers have a pivotal role in children’s oral health and care. Interventions aimed at improving children’s oral health should involve community outreach to engage caregivers in a culturally appropriate manner when their children are infants or toddlers.

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“…We included the number of active family and general practitioners and pediatricians per 1000 children in 2007, measured from the Area Resource File, because pediatric and general well-child care visits may influence dental care utilization. 26 The relationship between dentist supply and children's oral health may vary with the child's age because of changes in risk factors, including different stages of dental development, dietary and oral hygiene habits, social networks, and interactions between dentists and children. 27 Previous research has shown that the relationship between oral health and children's educational achievement and psychosocial well-being also varies with the child's age, 19 suggesting that dental care needs and effectiveness may vary with age.…”

Section: Discussionmentioning

confidence: 99%