Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program

Abstract

Background. Low-income, preschool-aged children with special health care needs (CSHCN) are at increased risk for poor oral health. The study goal was to assess preventive dental care use for Medicaid-enrolled CSHCN within Washington state’s Access to Baby and Child Dentistry (ABCD) Program. Methods. We analyzed 2012 Medicaid eligibility and claims files for children under age 6 years in the ABCD Program (N=206,488). Medical diagnosis and eligibility data were used to identify each child’s special needs status (no/yes). The outcome was preventive dental care use (no/yes). Modified Poisson regression models were used to estimate crude and covariate-adjusted prevalence rate ratios (PRR). Results. Of the 206,488 children in the study, 2.1% were CSHCN and 114,570 utilized preventive dental care (55.5%). CSHCN utilized preventive care at similar rates compared to children without SHCN (54.7% and 55.5%, respectively; P=0.32). After adjusting for confounders, CSHCN were significantly less likely to utilize preventive dental care than children without SHCN (PRR: 0.91; 95% CI: 0.88, 0.94; P<0.001). Older preschoolers were significantly more likely to use preventive dental care than younger preschoolers. A significantly higher proportion of preventive medical care utilizers also utilized preventive dental care. Conclusions. Medicaid-enrolled CSHCN in Washington’s ABCD Program were less likely to utilize preventive dental care than Medicaid-enrolled children without SHCN. Practical Implications. Future intervention research should evaluate strategies to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN in Medicaid.

A Machine Learning Approach to Uncovering Hidden Utilization Patterns of Early Childhood Dental Care Among Medicaid-Insured Children

“…This finding revealed an interplay between medical and dental conditions, which is consistent with previous findings. Craig et al found that children with special healthcare needs ( SHCN ) had more caries and were less likely to use preventative dental care ( 19 , 36 ). SHCN has been classified as a moderate risk for dental caries in children at 0–5 years ( 37 ).…”

“…Understanding ECDC utilization patterns is the first step in developing future interventions to prevent early childhood caries and reduce dental costs. Prior studies that examined ECDC utilization patterns have relied exclusively on supervised machine learning methods (e.g., logistic regression) where target outcomes are predefined (e.g., preventive dental care use, yes or no) ( 17 – 19 ). While supervised machine learning is popular and useful in examining relationships between predefined variables, they are incapable of uncovering meaningful hidden patterns that cannot be detected using predefined variables.…”

Association between Autism Spectrum Disorder and Caregiver-Reported Dental Caries in Children

“…First, caregivers of children with ASD need to be educated that their children have a greater odds of having dental caries. Second, children with ASD are in greater need of early access to preventive dental services due to the greater odds of having dental caries (Brickhouse et al 2009;Chi et al 2016;Craig et al 2019). In this study, approximately 86% of children with and without ASD received preventive dental care in the past year.…”

“…For example, we controlled for the child's use of preventive oral health care services because parents of children with ASD reported greater barriers to accessing care in the dental office as compared with their typically developing peers (Newacheck et al 2000;L.I. Stein et al 2012) and children with special health care needs were significantly less likely to use preventive dental care than children without special health care needs (Craig et al 2019).…”

Oral health behaviours and dental caries in low‐income children with special healthcare needs: A prospective observational study

“…10,11 A more recent study reported that Medicaid-enrolled CSHCN under age 6 years were significantly less likely to utilize preventive dental care than children without SHCN (prevalence rate ratio: 0.91; 95% CI: 0.88, 0.94; P < .001). 12 This may be because of differential barriers to dental care encountered by CSHCN. Paediatric dentists are maldistributed and general dentists may not feel sufficiently trained to treat medically complex CSHCN.…”