Cost-effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees

Stearns, Sally C.; Rozier, R. Gary; Kranz, Ashley M.; Pahel, Bhavna T.; Quiñonez, Rocio B.

doi:10.1001/archpediatrics.2012.797

Cited by 71 publications

(86 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PCP visits may reduce CRT because of children's increased opportunity to receive multiple fluoride varnish applications, which can prevent caries, especially when applied as new teeth emerge (Holve 2008;Lawrence et al, 2008;Slade et al, 2011;Stearns et al, 2012). Oral health services were allowed during approximately 3 PCP visits per year after most teeth erupt.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preventive Services by Medical and Dental Providers and Treatment Outcomes

et al. 2014

View full text Add to dashboard Cite

Objective: Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment. Methods: We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding. Results: We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment = $234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr. Conclusions: Because of children’s increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Prior studies suggest that PCP visits reduce dental caries-related treatment (CRT) (Pahel et al, 2011;Stearns et al, 2012). Additionally, having > 3 PCP visits was associated with lower Medicaid payments for CRT, suggesting fewer treatments within a treatment episode .…”

mentioning

confidence: 99%

Preventive Services by Medical and Dental Providers and Treatment Outcomes

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Individual-level studies demonstrate that the IMBP is effective in increasing access to preventive dental care and improving oral health outcomes for those who receive services. [14][15][16] The purpose of this study is to determine the impact of the IMBP, a statewide program targeting young children enrolled in Medicaid who use primary care medical services, on trends in dental caries among 5-yearold children. We anticipate a measurable population effect at the community level from providing IMBP services to low-income children who are most affected with dental caries, thus helping to reduce the disparities in oral health.…”

Section: Methodsmentioning

confidence: 99%

Office-Based Preventive Dental Program and Statewide Trends in Dental Caries

2014

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: To evaluate the impact of a North Carolina Medicaid preventive dentistry program in primary care medical offices (Into the Mouths of Babes Program [IMBP]) on decayed, missing, and filled teeth (dmft) of kindergarten students statewide and in schools with a large proportion of students from low-income families. METHODS: An ecologic study using panel data of 920 505 kindergarten students with 11 694 school-year observations examined the effect of the IMBP on dmft scores from 1998 to 2009. Ordinary least squares regression with fixed effects determined the association between IMBP visits per child 0 to 4 years of age per county and mean dmft scores per kindergarten student per school, controlling for school-level poverty and ethnicity, county-level Medicaid enrollment, and supply of dentists and physicians. RESULTS: Mean dmft per kindergarten student per school increased from 1.53 in 1998 to 1.84 in 2004, then decreased to 1.59 in 2009. The mean number of IMBP visits per child 0 to 4 years of age per county increased from 0.01 in 2000 to 0.22 in 2009. A 1-unit increase in IMBP visits per county was associated with a 0.248 (95% confidence interval, −0.40 to −0.10) decrease in dmft per kindergarten student per school. For schools with more students at high risk for dental disease, a 1-unit increase in IMBP visits was associated with a 0.320 (95% confidence interval, −0.55 to −0.09) decrease in dmft. CONCLUSIONS: IMBP reduced dental caries among targeted vulnerable children, which helped reduce oral health disparities among preschool-aged children in North Carolina.

show abstract

“…12,13 The literature suggests that physicians will adopt these services and provide quality care that is effective in increasing access to preventive services, reducing treatment needs, averting hospitalizations, and lowering Medicaid costs. [14][15][16][17][18][19][20] Studies reporting improved oral health have either provided circumstantial evidence on the basis of administrative claims 18,19 or have not examined comprehensive services, which include fluoride varnish applications. 15 This study extends previous work by evaluating the impact of comprehensive POHS, which includes screening and risk assessment, fluoride varnish applications, and parental oral health counseling, provided in medical offices by nondental providers, on the dental caries experience of children enrolled in North Carolina's (NC's) Medicaid program.…”

Section: What This Study Addsmentioning

confidence: 99%