Effects of Enrollment in Medicaid Versus the State Children’s Health Insurance Program on Kindergarten Children’s Untreated Dental Caries

Brickhouse, Tegwyn H.; Rozier, R. Gary; Slade, Gary D.

doi:10.2105/ajph.2007.111468

Cited by 36 publications

(24 citation statements)

References 12 publications

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“…Evaluation of examiner performance has demonstrated reliability and validity for these estimates, 18 and data have been used in a number of research studies. [19][20][21] For this study, the unit of analysis was the school year, and caries experience was measured as the school-level average number of dmft per screened kindergarten student.…”

Section: Outcome Variablementioning

confidence: 99%

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

2014

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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.

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Section: Outcome Variablementioning

confidence: 99%

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

2014

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“…Children from poor households are twice as likely to have untreated dental caries as children from higher income households (Dye et al, 2010). Furthermore, Medicaid-enrolled children are significantly more likely to have untreated caries than other children (Brickhouse et al, 2008). These factors have motivated efforts to address the ECC epidemic in socio-economically vulnerable children, in part, by ensuring access to preventive dental care.…”

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confidence: 99%

Economic Modeling of Sealing Primary Molars Using a “Value of Information” Approach

2014

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The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an "expected value of perfect information" (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategiesalways seal (AS) and standard care (SC) -with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: -$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.

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“…5 Although expansions in insurance coverage have improved access to oral health care, untreated tooth decay continues to be a significant problem, even for children with public insurance coverage. 6,7 A recent study found that children enrolled in Medicaid or the State Children's Health Insurance Program were 1.7 times more likely to have untreated dental caries than children not enrolled in one of these programs. 7 One explanation for children's oral health problems is the well-documented workforce shortage.…”

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confidence: 99%

“…6,7 A recent study found that children enrolled in Medicaid or the State Children's Health Insurance Program were 1.7 times more likely to have untreated dental caries than children not enrolled in one of these programs. 7 One explanation for children's oral health problems is the well-documented workforce shortage. 8 The current workforce of dentists in the United States is inadequate to meet the oral health care needs of children in terms of numbers of dentists, as well as their distribution, ethnicity, education, and practice orientation, and the situation may be getting worse as the dentist-to-population ratio continues to decline.…”

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confidence: 99%