Age of First Oral Health Examination and Dental Treatment Needs of Medicaid-Enrolled Children

Abstract

Introduction: Early childhood caries (ECC), despite being preventable, remains the most prevalent disease of childhood, particularly in children between the ages of 2 and 5 y. The association between the type of health care provider completing initial oral health examinations and subsequent dental caries in children under 6 y of age is unclear. Objective: The objective of the current study is to longitudinally assess the association between age at first oral health examination and provider type at first oral health examination on dental treatment for children under 6 y of age. Methods: Deidentified administrative claims data were used from the IBM Marketscan Multi-State Medicaid Database (n = 2.41 million Medicaid-enrolled children younger than 6 y in 13 states from 2012 to 2017). A Kaplan–Meier survival analysis was used to examine the association between age at first oral health examination and provider type with first treatment of dental caries at follow-up. Results: The adjusted hazard ratio (HR) of dental caries for children whose first oral health examination at 4 y of age is 5.425 times higher than for children whose first oral health examination was before 1 y of age (95% confidence interval [CI], 5.371–5.479). The adjusted HR of dental caries for children seen by pediatric dentists (HR = 1.215; 95% CI, 1.207–1.223) and physicians (HR = 2.618; 95% CI, 2.601–2.635) was higher than those seen by a general dentist. Conclusions: Findings from this study highlight the importance of children having their first oral health examination no later than 12 mo of age in accordance with existing guidelines and referrals from physicians to prevent the need for invasive treatment. Knowledge of Transfer Statement: Results of this study emphasize the need for a child’s first oral health examination to be completed no later than 12 mo of age to prevent dental caries. Reinforcement and referrals by physicians based on this recommendation facilitate early establishment of a dental home in young children.

Early Dental Visit Affects Dental Treatment in Korean Preschool Children Born Preterm: A Nationwide Population-Based Study

“…Given that preterm infants with a lower GA often have sequelae of prematurity, such as brain disorders [25][26][27], lung disorders [28-30], and lack of motor skills [31,32], they are more likely to receive periodic check-ups and treatments at general hospitals. Compared with physicians and general dentists, pediatric dentists are not only more knowledgeable about oral development and issues in infants and toddlers than general dentists or physicians [33,34], but they also provide more proactive interventions and a higher level of expertise in addressing oral problems [35]. Therefore, there is a higher likelihood of doctors assessing oral health issues early and referring comprehensive oral examinations to pediatric dentists at the same or nearby general hospitals.…”

Oral hygiene practice and home‐care challenges in children with autism spectrum disorder in San Francisco: Cross‐sectional study

“…This issue could be due to inadequately trained dental providers who are comfortable managing special-needs children and compounded by difficulty in locating dental offices that accept government funded insurance due to substantially lower reimbursement fees versus private dental insurances. 6,7,10,22,23 A recent study reported that in California 5% of dentists in suburban areas and 3% in rural areas participated in Medicaid program. 24 Only 11% of pediatric dentists in California participated in state's Medicaid program, which is one of the lowest in the USA.…”

“…There was no statistical difference between the groups. Literature showed that caries risk for children enrolled in Medicaid insurance when their first dental exams were at 4 years old is 5 times higher than those whose dental exams were before the age 1 21,22 . Hence, more awareness is needed so that children could be seen for their first dental exam by age 1.…”

“…Many studies in the past have cited this problem faced by parents in finding a dentist willing to work with special healthcare needs population. This issue could be due to inadequately trained dental providers who are comfortable managing special‐needs children and compounded by difficulty in locating dental offices that accept government funded insurance due to substantially lower reimbursement fees versus private dental insurances 6,7,10,22,23 …”

Considering the Vulnerable Populations of Young and Old

“…It is no surprise that many of the reports in this January 2023 issue focus on 2 of the most vulnerable populations worldwide for poor oral health: children and older adults. Ahmed et al (2021) describe a quantitative analysis of almost 2.5 million children enrolled in the US Medicaid system. Consistent with previous published literature, their analysis indicates that children who have their first dental visit at the age of 4 y have significantly higher hazard ratios for dental caries (more than 5 times greater) than children who have their first dental visits at the age of 1 y.…”