Timing of First Dental Visits for Newly Medicaid-Enrolled Children With an Intellectual or Developmental Disability in Iowa, 2005–2007

Abstract

Objectives We evaluated the relationship between having an intellectual or developmental disability (IDD) and the timing of the first dental visit for children who were newly enrolled in Medicaid in Iowa. Methods We identified children aged 3 to 8 years with and without IDD who were newly enrolled in the Iowa Medicaid program in 2005 (N=5391). We gathered data on presence of IDD, health status, age at baseline, gender, length of Medicaid enrollment, medical care visits, household Medicaid enrollment, urbanization, residence in a federally designated Health Professional Shortage Area (HPSA), and time of first dental visit through 2007. Results About 32% of children had a first dental visit within 6 months of enrollment; this proportion increased to 49%, 64%, and 74% by years 1, 2, and 3, respectively. In the unadjusted models, there was no significant difference between children with and without IDD in time to first dental visit (P=.22). After adjusting for model covariates, however, children with IDD were 31% more likely to have a delayed first dental visit (P=.04). Conclusions Newly Medicaid-enrolled children aged 3 to 8 years with IDD in Iowa were significantly more likely to have a later first dental visit. Future interventions should focus on ensuring timely access to first dental visits for all Medicaid-enrolled children, with an emphasis on those with IDD.

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

“…Ascribed factors are modeled as confounders: child’s sex (male/female); child’s race, a factor related to the timing of dental visits for children 31 , as reported by the child’s caregiver (White/non-White/missing); whether the child was at risk for developing a chronic condition (no/yes), a measure developed in consultation with a pediatrician with expertise in chronic conditions (personal communication, Dr. John Neff) (defined as an ICD-9-CM, CPT, or Healthcare Common Procedure Coding System [HCPCS] codes indicating ventilator use, gastrostomy, tracheotomy, premature birth, low birth weight, infantile seizures, or newborn apnea during the first 16 months of life) 26 ; and whether the child was eligible for Medicaid through the Supplemental Security Income (SSI) Program for ≥6 months during the first year of life (no/yes), a measure of chronic condition severity. 3 …”

“…23 Previous studies report associations between preventive medical and dental care use as well as use of preventive medical care and the timing of first dental visits for Medicaid-enrolled children ages 3–8. 24–26 However, no study has focused on the relationship between WBV and first dental examinations for young Medicaid-enrolled children under age 3, with an emphasis on how the frequency and timing of WBV are related to the timing of first dental examinations.…”

“…We focused on WBV because of the conceptual link between medical and dental care use. 24–26 These first two hypotheses are based on the premise that WBV are proxies for health-related behaviors and beliefs influenced by the “motivations, values, and personal preferences” for earlier first dental examinations by caregivers. 27 The third hypothesis is based on the premise that factors at the system-, community-, and family-level make up the milieu in which decisions are made by caregivers to seek dental care for their child.…”

Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

“…We had hypothesized children with ASD would be at greater risk for NTDC-related ED visits and higher costs because of documented difficulties accessing dental care and high levels of unmet dental care need (Newacheck et al 2000; Brickhouse et al 2000; Lai et al 2012; Chi et al 2011b). Untreated tooth decay is the main driver of NTDC-related ED visits and visits to the dentist are intended to help prevent tooth decay (Sun and Chi 2014).…”

“…The fourth is poor access to dental care. Children with intellectual and developmental disabilities and ASD have poor access to timely preventive dental care (Chi et al 2011b; Barry et al 2014). Many dentists are hesitant about treating patients with ASD who are uncooperative in dental office settings (Casamassimo et al 2004; Loo et al 2008).…”