Sociodemographic Distribution of Pediatric Dental Caries: NHANES III, 1988–1994

Vargas, Clemencia M.; Crall, James J.; Schneider, Donald A.

doi:10.14219/jada.archive.1998.0420

Cited by 328 publications

(251 citation statements)

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“…1 It is estimated that 2% of infants 12 to 23 months of age in the United States have at least 1 tooth with questionable decay, whereas 19% of children 24 to 60 months of age meet the criteria for ECC. 2 ECC is much more prevalent among children from low-income families; for example, among children 3 to 5 years of age in Head Start, the prevalence of ECC has been reported to be as high as 90%. 3,4 Untreated caries is concentrated disproportionately among children from the lowest family income levels, and the incidence decreases as income increases.…”

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“…3,4 Untreated caries is concentrated disproportionately among children from the lowest family income levels, and the incidence decreases as income increases. 2 Among children 2 to 5 years of age who are living at or below the federal poverty level, almost 80% of their decayed primary teeth have not been restored. 2 Dental care is the most prevalent unmet health care need of poor US children of all ages, with preschool-aged children being especially vulnerable.…”

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“…2 Among children 2 to 5 years of age who are living at or below the federal poverty level, almost 80% of their decayed primary teeth have not been restored. 2 Dental care is the most prevalent unmet health care need of poor US children of all ages, with preschool-aged children being especially vulnerable. 5 ECC has far-reaching effects beyond the consequences of decayed teeth.…”

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Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs

Savage¹,

Lee²,

et al. 2004

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ABSTRACT. Objective. To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children.Design. This investigation studied North Carolina children who were enrolled continuously in Medicaid from birth for a 5-year period. Our research design was a longitudinal cohort study that relied on 4 large administrative datasets, including North Carolina composite birth records from 1992, Medicaid enrollment and claims files from 1992 to 1997, and the Area Resource File. Our outcome measures included type of use and dentally related costs.Results. Of the 53 591 Medicaid-enrolled children born in 1992, 9204 were continuously enrolled for 5 years and met our inclusion criteria. Twenty-three children had their first preventive dental visit before 1 year of age, 249 between 1 and 2 years, 465 between 2 and 3 years, 915 between 3 and 4 years, and 823 between 4 and 5 years. Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. Those who had their first preventive visit at age 2 or 3 were more likely to have subsequent preventive, restorative, and emergency visits. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1, $262; age 1 to 2, $339; age 2 to 3, $449; age 3 to 4, $492; age 4 to 5, $546.Conclusions. Our results should be interpreted cautiously, because of the potential for selection bias; however, we concluded that preschool-aged, Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs. In addition, children from racial minority groups had significantly more difficulty in finding access to dental care, as did those in counties with fewer dentists per population. Pediatrics 2004;114:e418-e423. URL: www.pediatrics.org/ cgi/doi/10.1542/peds.2003-0469-F; early childhood caries, preventive dental visit, cost, first dental visit, Medicaid dental use.ABBREVIATIONS. ECC, early childhood caries; NC, North Carolina; DPCR, number of dentists per 10 000 population according to county of residence. E arly childhood caries (ECC) is defined as dental decay among children Յ5 years of age. 1 It is estimated that 2% of infants 12 to 23 months of age in the United States have at least 1 tooth with questionable decay, whereas 19% of children 24 to 60 months of age meet the criteria for ECC. 2 ECC is much more prevalent among children from low-income families; for example, among children 3 to 5 years of age in Head Start, the prevalence of ECC has been reported to be as high as 90%. 3,4 Untreated caries is concentrated disproportionately among...

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Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs

Savage¹,

Lee²,

et al. 2004

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“…2 This survey also revealed that caries in primary teeth varies by poverty status-the lowest income groups have 2 to 5 times more caries than high-income groups. 3 Both the medical and dental professions promote the importance of physicians' involvement in oral health promotion and the prevention of early childhood caries, 4 -6 defined as any sign of dental caries on any tooth surface during the first 3 years of life. 2 Despite interest in physicians playing an active role in children's oral health, there are few welldeveloped practice guidelines for physicians to follow when performing dental screenings or other activities related to infant oral health.…”

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Accuracy of Pediatric Primary Care Providers’ Screening and Referral for Early Childhood Caries

2002

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ABSTRACT. Purpose. Tooth decay is one of the more common diseases of childhood. Slightly >40% of US children are already affected by the time they reach kindergarten. Primary care physicians can play an important role in prevention and control of this disease because of their ready access to this population. Unlike dentists, they see a large percentage of children during their infant and toddler years. However, few studies have been conducted on oral screenings and referrals by primary care physicians or the effectiveness of their oral health preventive activities. The purpose of this study was to determine the accuracy of pediatric primary care providers' screening and referral for Early Childhood Caries.Methods. We sought to compare independent, blinded oral screening results and referral recommendations made by primary care providers with those of a pediatric dentist, considered for purposes of the study to be the reference gold standard. The study was conducted at a private pediatric group practice in North Carolina. The practice was selected because it serves a large volume of Medicaid patients and includes a large number of pediatric primary care providers (11 pediatricians and 1 nurse practitioner). Study participants included Medicaid-eligible children younger than 36 months of age with erupted teeth. The pediatric primary care providers in this practice received 2 hours of training in infant oral health. The training consisted of a review of the study methods and clinical slides illustrating dental caries in various stages of progression. Specific instructions were given to the providers on how to recognize a cavitated carious lesion and how to determine when a dental referral is needed. Providers were instructed to refer any child with 1 or more cavitated carious lesions, soft tissue pathology, or evidence of trauma to the teeth or mouth. Before commencing the study, calibration and a comparative analysis were performed to establish reliability and validity of the examinations performed by the pediatric dentist. Both a pediatric dentist and a pediatric primary care provider conducted a dental screening on each child and recorded carious teeth and whether a dental referral was needed. Sensitivity and specificity were calculated to compare the pediatric primary care providers' screenings to the gold standard (pediatric dentist) in 3 categories: caries at the tooth level, caries at the patient level (1 or more affected teeth), and need for referral.Results. The final study sample consisted of 258 preschool-aged children (122 males and 136 females) with a mean age of 21.2 months (standard deviation [SD]: 9.13).One hundred eighty-four (71.3%) of the participants were white, 58 (22.5%) were black, and 16 (6.2%) were Hispanic.Tooth Dental Referral: The pediatric dentist referred a total of 27 (10.5%) children to a dentist. Two of these children were referred for trauma and the other 25 were referred for cavities. The pediatric primary care providers referred a total of 23 (8.9%) children to a dentist. Two ref...

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“…Children from low-income families experience more dental disease and have reduced access to dental care, resulting in fewer opportunities for prevention and higher levels of unmet dental treatment needs. 1,2 Only 1 in 5 children enrolled in Medicaid ever receives a preventive dental visit, and increased levels of oral disease are being seen in this population of children. 3 In the Roanoke Valley of Virginia, and most other parts of the nation, the problem is exacerbated by a shortage of pediatric dentists accepting Medicaid, a lack of parental education and literacy on oral health and hygiene, language and cultural barriers to care, and rural areas depending on private, nonfluoridated wells for water.…”

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The Impact of a Home Visiting Program on Children’s Utilization of Dental Services

Brickhouse

Haldiman²,

Evani

2013

Pediatrics

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BACKGROUND: Child Health Investment Partnership (CHIP) of Roanoke Valley is a home visiting program that promotes children’s health and family self-sufficiency. CHIP’s Begin With a Grin program provides preventive dental services in the home (oral health anticipatory guidance and fluoride varnish) for children aged 0 to 6 years. The purpose of this study was to compare the dental utilization of Medicaid-enrolled children in CHIP versus Medicaid-enrolled children not in CHIP. METHODS: Using the propensity score method, control subjects were selected from the statewide Medicaid database by using a caliper-matching algorithm. A vector of chosen covariates was used to match control subjects; these covariates included risk factors, estimated propensity score, age, race, gender, and days of Medicaid eligibility. Propensity scores were developed by using a logistic regression. Differences in dental utilization outcomes were tested: ≥1 dental claim (logistic regression) and number of dental claims (Poisson regression) for each subject within the test period. RESULTS: When CHIP children were compared with Medicaid-only children, the CHIP child was 3 times more likely to have at least 1 dental visit (odds ratio: 3.0 [95% confidence interval: 1.9–4.7]) and have a higher number of dental claims (ratio of estimated average number of dental claims [cases/control]: 8.60/3.05 = 2.82 [95% confidence interval: 2.56–3.12]). CONCLUSIONS: A home visiting model can introduce children and their families to dental prevention, improve dental health literacy, establish a dental home, and provide application of fluoride varnish.

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Sociodemographic Distribution of Pediatric Dental Caries: NHANES III, 1988–1994

Cited by 328 publications

References 4 publications

Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs

Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs

Accuracy of Pediatric Primary Care Providers’ Screening and Referral for Early Childhood Caries

The Impact of a Home Visiting Program on Children’s Utilization of Dental Services

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