Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program

Dentophobia and the Interaction Between Child Patients and Dentists: Anxiety Triggers in the Dental Office

Dental anxiety is an intense and irrational fear of visiting the dentist or of undergoing dental procedures.

BACKGROUND/OBJECTIVES

The aim of this study was to investigate the prevalence of dental anxiety in children aged 6-11 years and to identify the importance of communication in reducing anxiety in pediatric patients.

METHODS

The research was conducted through a questionnaire administered to 101 students (55.4% girls and 44.6% boys), aged 6-11 years, from the North-West Region of Romania. The data collected included the age and gender of the subjects, their previous experiences with the dentist, the identification of factors that trigger anxiety, and the way in which patients perceive future dental visits.

RESULTS

This study found that for the majority of participants, a visit to the dentist does not represent a source of fear. Moreover, most children are eager to visit the dentist again. Gender and age did not have a significant effect on the prevalence of anxiety. Elements such as sitting in the dental chair, observing dental instruments, having the teeth examined with a mirror, and hearing the sounds produced by the instruments were identified as factors that may cause anxiety in pediatric patients.

CONCLUSIONS

It was found that pediatric patients who have good communication with the practitioner display lower anxiety levels compared to those of others.

How Can We Reduce Dental Fear in Children? The Importance of the First Dental Visit

Dental fear is a common problem amongst children. It can affect children’s psychological well-being, quality of life, and oral and systemic health. The aim of this study was to identify whether the patients’ age at which visits to the paediatric dentist begin as well as the periodicity of these visits are factors that can prevent dental fear. This observational transversal study was conducted on 575 school children (average age 6.85 ± 0.78) and their mother/father/guardian. Parents completed a survey on the characteristics of dental visits and the child completed the index of dental anxiety and fear (IDAF-4C) to assess dental fear. The correlation between dental fear and age at first visit (r = −0.36 p < 0.01) and dental fear and frequency of visit (r = −0.65 p < 0.01) were statistically significant. The regression analysis performed showed that both variables predicted 44.4% of the dental fear in the child. In conclusion, the age of initiation to the paediatric dentist (before 2 years) and the periodic revisions (every 6 months or every year) could protect the child from dental fear.

The Impact of COVID-19 on Preventive Oral Health Care During Wave One

Introduction: Early childhood caries burdens children, their families, and the health care system. Utilizing fluoride varnish at medical well-child visits with non-dental primary care providers can be an interprofessional strategy to combat early childhood caries. The COVID-19 pandemic dramatically altered preventive health care delivery and the effects on preventive oral health care delivery have not been previously described.

Methods: This analysis used descriptive statistics and non-parametric Wilcoxon Mann-Whitney tests to compare preventive oral health utilization among 1 to 5-year old children in two state Medicaid agencies before and during the pandemic. Fluoride utilization rates at dental visits and medical well-child visits were calculated as number of users per 1,000 enrolled children. Additionally, the proportion of well-child visits that included fluoride application was calculated for each state.

Results: During the pandemic, the quarterly fluoride utilization rate significantly decreased at dental visits (pre-pandemic = 153.5 per 1,000 enrolled children; pandemic = 36.1 per 1,000 enrolled children, p &lt; 0.001) and signficantly decreased at medical well-child visits (pre-pandemic = 72.2 per 1,000 enrolled children; pandemic = 32.3 per 1,000 enrolled children, p = 0.03) during the pandemic.

Conclusions: The findings highlight the importance of interprofessional collaboration among non-dental primary care providers and dental providers to provide access to preventive oral health services, particularly when access to dentists is limited. Future directions might include rigorous evaluations of co-located medical and dental services or the use of interprofessional telehealth technologies.

Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia

Aim

The present study aimed to assess and compare the efficacy of acupressure, hypnosis and audiovisual aids in reducing anxiety in children during the administration of local anesthesia (LA).

Methodology

Two hundred apparently healthy children were selected randomly between 6 and 10 years of age and were divided into 4 groups with 50 children in each group. Group I: children were subjected to hypnosis, group II: acupressure, group III: AV aids i.e., VPT, and group IV: children were the control group where no anxiety-reducing techniques were used during administration of LA. The anxiety scores were recorded at three different time intervals by recording the pulse rate (PR), respiratory rate (RR) and anxiety rate (AR) and subjected to statistical analysis.

Results

The results showed that, all the three distraction techniques showed a significant reduction in PR, RR and AR at all time intervals, when compared to the control group. A significant reduction in PR, RR and AR was seen in the hypnosis group when compared to acupressure and only PR in comparison to AV aids. There was no significant difference between group II and III in reducing anxiety.

Conclusion

The present study indicates that all the three distraction techniques were effective in reducing anxiety in children. Hypnosis was most promising, followed by audiovisual aids and acupressure.

Clinical significance

The techniques can be utilized in a day-to-day practice to manage patients with anxiety.

How to cite this article

Erappa U, Konde S, Agarwal M, et al. Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S186-S192.

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

BACKGROUND

Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state's Access to Baby and Child Dentistry (ABCD) program.

METHODS

The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child's special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios.

RESULTS

Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care.

CONCLUSIONS

CSHCN who were enrolled in Medicaid in Washington's ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid.

PRACTICAL IMPLICATIONS

Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.

Decreasing disruptive behaviour during routine dental visits: a video modelling intervention for young children

OBJECTIVE

To evaluate the benefits of a collaborative partnership between paediatric dentists and behavioural health providers in which a practical video modelling intervention, with the aim to reduce disruptive behaviours in young children, is implemented.

METHODS

The video was created by a dentist using readily available technology and implemented in a busy practice setting. A clinical sample of 40 children, 3-6 years old, was recruited from a continuous sample of patients seen at the clinic. Participants were randomised into two groups and shown either the brief video model or a control video prior to a routine dental visit. All sessions were videotaped and independently scored by blinded observers. Behavioural data were recorded using 15-second partial-interval recording and included physical and vocal disruptions. Subjective measures of cooperation were also completed by observers and dental professionals.

RESULTS

Independent samples t-tests show that the treatment group had a significantly lower mean percentage of intervals in which disruptive behaviour was observed [t(38) = 2.94, P = 0.008] compared with the control group. Subjective rating scales revealed significantly higher ratings of cooperation for the treatment group from the dentist [t(38) = -5.19, P = 0.000], the dental assistant [t(38) = -4.01, P = 0.001] and the blinded coder [t(38) = -3.54, P = 0.002]. Significant relationships were found between the percentage of actual disruptive behaviour and subjective ratings of the dentist (r = -0.82, P < 0.01).

CONCLUSIONS

Watching a brief dentist-created video model of expected procedures can reduce disruptive behaviour and increase cooperation for young children making their first visit to a busy medical setting.

Fluorides and Other Preventive Strategies for Tooth Decay

We focus on scalable public health interventions that prevent and delay the development of caries and enhance resistance to dental caries lesions. These interventions should occur throughout the life cycle, and need to be age appropriate. Mitigating disease transmission and enhancing resistance are achieved through use of various fluorides, sugar substitutes, mechanical barriers such as pit-and-fissure sealants, and antimicrobials. A key aspect is counseling and other behavioral interventions that are designed to promote use of disease transmission-inhibiting and tooth resistance-enhancing agents. Advocacy for public water fluoridation and sugar taxes is an appropriate dental public health activity.

Provision of Preventive Dental Services in Children Enrolled in Medicaid by Nondental Providers

OBJECTIVES

Aims of this study are to determine (1) the association of oral health services (OHS) provided by nontraditional providers with the percentage of Medicaid children 0 to 5 years of age who receive ≥1 preventive services from all provider types in the United States; and (2) characteristics of state Medicaid policies associated with provision of OHS.

METHODS

We conducted a time-series cross-sectional study of preventive services provided by nontraditional (OHS) and dental (PDS) providers for Medicaid-enrolled children from birth to 5 years of age in all states during 2010 to 2013 (204 observations). We applied panel data multiple regression analysis techniques to exploit year and state variation in aggregate data available in Centers for Medicare and Medicaid Services reports (form CMS-416). Total preventive dental services (TPDS =OHS + PDS) was predicted by months since state enactment of a policy to reimburse medical providers for OHS.

RESULTS

The 44 states with a policy reported 4.3% of children per state per year with any OHS. For all states, an average of 30.1% received PDS and 34.5% TPDS. The delivery of OHS was associated with a small increase in percentage with TPDS. One year of Medicaid OHS availability was associated with an increase of 1.5% in the percentage of children with TPDS per state per year.

CONCLUSIONS

Implementation of policies by Medicaid programs to support integration of OHS into primary care is associated with increases in overallTPDS use, but efforts are needed to improve implementation in practice to achieve national impact on access.

Parent, Dentist, and Independent Rater Assessment of Child Distress During Preventive Dental Visits

PURPOSE

Although typically not painful, preventive dental care can be distressing to young children. A greater understanding of how adults perceive child distress may enable clinicians to improve the patient/parent experience through alignment of values and facilitation of shared decision-making. The purpose of this study was to examine the association between parent, dentist, and independent observer (IO) ratings of child distress during preventive dental procedures.

METHODS

Sixty-five children younger than three years were seen for preventive dental care at a university dental clinic. Parents, dentists, and an IO rated intensity of child distress during four phases of the dental visit: (1) pre-exam; (2) positioning; (3) prophylaxis/exam/fluoride; and (4) post-exam.

RESULTS

The average age of the children was 24.4 months old (±7.2 SD). The prophylaxis/exam/fluoride phase was judged to be most distress inducing. Mean distress ratings for this phase were: 2.30 (parents); 2.47 (dentists); and 3.08 (IO), which was statistically significant (P=.04). The IO ratings were significantly different from parents (for three phases) and dentists (for one phase); no statistically significant differences were noted between parent and dentist ratings for any phase.

CONCLUSIONS

There was a strong agreement between parents' and dentists' ratings of child distress during preventive dental procedures.

Dental attendance among low-income women and their children following a brief motivational counseling intervention: A community randomized trial

This study tested a behavioral intervention to increase dental attendance among rural Oregonian low-income women and their children. It utilized a multi-site, single-blind, randomized trial design. Four hundred women were randomized into one of four conditions to receive prenatal or postpartum motivational interviewing/counseling (MI) or prenatal or postpartum health education (HE). Counselors also functioned as patient navigators. Primary outcomes were dental attendance during pregnancy for the mother and for the child by age 18 months. Attendance was obtained from the Oregon Division of Medical Assistance Programs and participant self-report. Statewide self-reported utilization data were obtained from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS). Maternal attendance was 92% in the prenatal MI group and 94% in the prenatal HE group (RR = 0.98; 95% CI = 0.93-1.04). Children's attendance was 54% in postpartum MI group and 52% in the postpartum HE group (RR = 1.03; 95% CI = 0.82-1.28). Compared to statewide PRAMS, attendance was higher during pregnancy for study mothers (45% statewide; 95% CI = 40-50%) and for their children by 24 months (36% statewide; 95% CI = 27-44%). MI did not lead to greater attendance when compared to HE alone and cost more to implement. High attendance may be attributable to the counselors' patient navigator function.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT01120041.

Parent-reported distress in children under 3 years old during preventive medical and dental care

PURPOSE

This study examined factors related to young children's distress during preventive oral health visits. Additionally, associations between parent-reported child behaviour during the dental visit and during previous medical visits were tested.

METHODS

One hundred twenty-two children under 3 years of age enrolled in a government insurance programme for low-income children were seen for examination, prophylaxis, and fluoride application at a university-based dental clinic. Child distress was rated by parents on a numerical rating scale.

RESULTS

The average age of children enrolled was 23.5 ± 7.3 months. The majority (55.7 %) were judged to have little or no distress pre-examination. Mild or no distress during the examination was reported for 42.6 % of the children and severe distress was reported for 39.4 %. Intensity of distress during the examination was not associated with the child's age, gender, dental health, or previous experience with dental care. Distress was also unrelated to the caregiver's education level or own dental health. Intensity of distress was associated with the child's pre-dental examination distress and distress during prior medical examinations and injections.

CONCLUSIONS

Dental professionals can better anticipate child distress by assessing children before a dental examination and enquiring about previous medical experiences. Strategies to prepare parents and alleviate distress may help children cope with the preventive dental visit.

From public mental health to community oral health: the impact of dental anxiety and fear on dental status

Dental fear is a widely experienced problem. Through a “vicious cycle dynamic,” fear of dental treatment, lower use of dental services, and oral health diseases reinforce each other. Research on the antecedents of dental anxiety could help to break this cycle, providing useful knowledge to design effective community programs aimed at preventing dental fear and its oral health-related consequences. In this regard, frameworks that analyze the interplay between cognitive and psychosocial determinants of fear, such as the Cognitive Vulnerability Model, are promising. The onset of dental fear often occurs in childhood, so focusing on the child population could greatly contribute to understanding dental fear mechanisms and prevent this problem extending into adulthood. Not only can public mental health contribute to population health, but also community dentistry programs can help to prevent dental fear. Regular dental visits seem to act in a prophylactic way, with dental professionals playing an important role in the regulation of the patients’ anxiety-related responses. Both public mental health and community dentistry could therefore benefit from a multidisciplinary approach to dental fear and oral health.

Factors affecting age at first dental exam for Medicaid-enrolled children seen at Federally Qualified Health Centers

PURPOSE

The purpose of this study was to estimate age at first dental visit (FDV) and identify variables predicting earlier visits for Medicaid-enrolled children at Iowa Federally Qualified Health Centers (FQHC).

METHODS

Statewide Medicaid claims data were used to draw a random sample of children who received their FDV prior to six years old at a FQHC, were Medicaid-enrolled within the first two months of life, and remained continuously enrolled over the study period. Forty children from each of five FQHCs had their dental charts abstracted and merged with other Medicaid records and birth certificate data. The logarithmic age at FDV was regressed against several predictor variables.

RESULTS

Mean and median ages for FDV were 25.6 and 23 months old, respectively. When controlling for other variables, there were differences in FDV age according to: mother's marital status (P=.04); whether the child had any medical well-child visits (MCVs) at a FQHC prior to the FDV (P<.001); and which FQHC the child visited. Only approximately 28 percent of these children, however, had any MCV at the FQHC.

CONCLUSIONS

Medicaid-enrolled children who visited Federally Qualified Health Centers for their first dental visit were seen at an earlier age than previously recorded for such health centers (mean=four years old). Children who also received any medical well-child visits at FQHCs were more likely to have earlier FDVs.

Preventive Dental Care Utilization For Preschool-Aged Children in Medicaid: Parents' Perceptions and Experiences With Medicaid Dentists

BACKGROUND

Studies on the barriers to preventive dental care for preschool-aged children in Medicaid often focus on whether parents understand the importance of preventive dental care. Fewer studies have examined the perceptions and experiences of parents once their child begins utilizing dental care. This qualitative study of parents who are using preventive dental care for their preschool-aged, Medicaid enrolled children uses parental perceptions and experiences to help us understand the barriers to preventive dental care.

METHODS

This qualitative study focused on 41 parents who participated in focus groups designed to uncover barriers and facilitators to preventive dental care use for young children in Medicaid.

RESULTS

Parents of preschool-aged children enrolled in Medicaid face a number of barriers when trying to utilize preventive dental care, even when the parents are experienced with accessing care for their young children. These barriers can be broadly categorized into system-level barriers and provider-level barriers. System-level barriers are related to the low number of dentists who accept Medicaid and/or young children. Provider-level barriers are centered on dentist behavior or clinic environment.

CONCLUSION

Families of preschool-aged children in Medicaid continue to encounter barriers to preventive care even after the child initially utilizes care, which suggests that access to dental care is an ongoing problem for young Medicaid-enrolled children. Interventions that address system-level and provider-level barriers to care can help to ensure continual access to preventive dental care through childhood for Medicaid-enrolled children.

County-level determinants of dental utilization for Medicaid-enrolled children with chronic conditions: how does place affect use?

Little is known about how place affects childrens' access to dental care. We analyzed data for 25,908 Iowa Medicaid-enrolled children with chronic conditions to identify the county-level determinants of dental utilization. Our analyses suggest that higher levels of poverty and designation as a dental health professional shortage area at the county-level are associated with lower probability of child-level dental use. There are significant interactions between child-level race/ethnicity and county-level poverty as well as between child-level disability and county-level unemployment. We present a new descriptive model on dental utilization that emphasizes county-level factors as well as interactions between county-level and child-level factors.

Parents' perspectives on a dental home for children with special health care needs

The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.

Treatment experience, frequency of dental visits, and children's dental fear: a cognitive approach

Cognitive elements play a key role in dental anxiety. Nevertheless, relatively little is known about how dental treatments and frequency of visits to the dentist are related to dental fear and its cognitive antecedents. This study aimed to explore the relationships between dental visits, past treatment experiences, expectations on the aversiveness/probability of negative dental events, and dental fear in children. The participants were 147 children (60% female; mean age = 12.0 yr) who completed a questionnaire comprising measures of dental treatment-related experience (attendance, fillings, and extractions), perceived aversiveness and probability of dental events, and dental anxiety. Bivariate correlations and multiple linear regression analyses were used to analyze the data. A higher frequency of dental visits was associated with less dental fear and a decreased belief in the probability of negative events occurring during treatment. The type of treatments received was not directly linked to dental fear. However, having received fillings was significantly associated with the perceived probability of negative dental events, whereas extractions were positively associated with these expectations but negatively associated with the perceived aversiveness of possible dental events. Regular dental visits, as well as dental treatments, can influence, in different ways, cognitive elements associated with dental anxiety in children.

Empowering Head Start to improve access to good oral health for children from low income families

Surveys over 20 years have documented worsening in the dental health of preschoolers. Healthy People 2010 Midcourse Review reports the country moving away from oral health goals for young children; the slip is 57%. Exacerbating this is the inability of Medicaid to provide for those in need. Most children receive examinations only: few receive comprehensive care. We urge Head Start grantees to adopt a new approach to oral health goals and in this paper offer: (1) a review of the problem and premises preventing a solution; (2) a proposal that Head Start adopt a public health perspective; and (3) specific roles staff and dental personnel can take to mount aggressive strategies to arrest tooth decay at the grantee site.

The impact of Medicaid insurance coverage on dental service use

The new comprehensive health reform, beginning in 2014, will require Medicaid to expand all elements of coverage to individuals with incomes up to 133 percent of the federal poverty line. With millions more individuals gaining eligibility for adult Medicaid dental benefits, generating an unbiased estimate of the elasticity of demand for dental services is critical. The causal relationship between access to adult Medicaid dental benefits and usage of dental services for low-income adults is estimated, using difference-in-differences estimation procedures to exploit the state-level variation in adult Medicaid dental benefits. Results suggest that adult Medicaid dental benefits increase the probability of a dental visit within 12 months by 16.4-22 percent. A variety of robustness checks are invoked to confirm the finding.

Dentists' perceptions of barriers to providing dental care to pregnant women

PURPOSE

The purpose of the study was to understand US dentists' attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely.

METHODS

In 2006 and 2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists' attitudes toward providing care to pregnant women, dentists' knowledge about the safety of dental procedures, and dentists' current practice patterns.

RESULTS

Dentist's perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 (p = .12; n = 772; df = 52) and a Bentler-Bonett normed fit index of .98 and a comparative fit index of .993. The root mean square error of approximation is .02.

CONCLUSION

Findings suggest that attitudes are significant determinants of accurate knowledge and current practice. Multidimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second, and third trimesters, dentists' knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.

Factors affecting dental fear in French children aged 5-12 years

BACKGROUND

While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting.

OBJECTIVE

We set out to evaluate factors affecting dental fear in French children.

METHODS

Dental fear was evaluated using a visual analogue scale (DF-VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5-11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well-being related to oral health, dental experience, and oral health education were collected via a structured interview.

RESULTS

Dental fear was scored low in 75.7% (DF-VAS 0-3), moderate in 16.7% (DF-VAS 4-6), and high in 7.6% (DF-VAS 7-10). DF-VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care.

CONCLUSIONS

This study shows that for children aged 5-12 years, prior experience of the dental setting can act as a positive component of dental fear.

Linking mother access to dental care and child oral health

OBJECTIVES

The authors examined whether low-income mothers, who have a regular source of dental care (RSDC), rate the dental health of their young children higher than mothers without an RSDC.

METHODS

From a population of 108,151 children enrolled in Medicaid aged 3 to 6 years and their low-income mothers in Washington state, a disproportionate stratified random sample of 11,305 children aged 3 to 6 years was selected from enrollment records in four racial/ethnic groups: 3791 Black; 2806 Hispanic; 1902 White; and 2806 other racial/ethnic groups. A mixed-mode survey was conducted to measure mother RSDC and mother ratings of child's dental health and pain. The unadjusted response rate was 44%, yielding the following eligible mothers: 816 Black, 1309 Hispanic, 1379 White, 237 Asian, and 133 American-Indian. Separate regression models for Black, Hispanic, and White mothers estimated associations between the mothers having an RSDC and ratings of child dental health.

RESULTS

Across racial/ethnic groups, mothers with an RSDC consistently rated their children's dental health 0.15 higher on a 1-to-5 scale (where '1' means 'poor' and '5' means 'excellent') than mothers without an RSDC, controlling for child and mother characteristics and the mothers' propensity to have an RSDC. This difference can be interpreted as a net movement of one level up the scale by 15% of the population.

CONCLUSIONS

Across racial/ethnic groups, low-income mothers who have a regular source of dental care rate the dental health of their young children higher than mothers without an RSDC.

Preventive dental care for young, Medicaid-insured children in Washington state

BACKGROUND

Children from low-income families face barriers to preventive dental care (PDC) and are disproportionately affected by dental caries. The Access to the Baby and Childhood Dentistry (ABCD) program of Washington State is targeted to Medicaid-insured children <6 years of age to improve their access to PDC.

OBJECTIVES

To test the hypothesis that residing in an ABCD county improves the likelihood of receiving PDC and, to compare PDC use among young, Medicaid-insured children in Washington to national statistics.

METHODS

We extracted 2003 Washington Medicaid dental claims for continuously enrolled children <or=6 years of age. Multivariable analysis was performed to identify variables independently associated with >or=1 preventive dental visit (PDV) in 2003. For national comparison, we used the 2003 Medical Expenditure Panel Survey (MEPS).

RESULTS

Among Medicaid-insured children <or=6 yrs of age from WA counties with ABCD program, 45% had at least 1 PDV compared with 36% from non-ABCD counties (P < .001) and 37% of US children with continuous private insurance (P < .001). There were significantly higher adjusted odds of a PDV for children from ABCD counties relative to non-ABCD counties (odds ratio: 1.30 [95% confidence interval: 1.05-1.60]).

CONCLUSIONS

We confirmed our hypothesis that residing in an ABCD county was associated with a higher likelihood of having >or=1 PDV in 2003. We also found that significantly more children in established ABCD counties received PDC compared with privately insured US children. These findings provide additional evidence that the ABCD program reduces disparities in dental care access among young, Medicaid-insured children in Washington and point to the importance of expanding the ABCD program to other states.

Preventive dental service utilization for Medicaid-enrolled children in New Hampshire: a comparison of care provided by pediatric dentists and general dentists

In this study, we compared preventive dental utilization through visits to a pediatric dentist (PD) vs. visits to a general dentist (GD) among Medicaid-enrolled children in New Hampshire (n = 12,964). Dental claims were analyzed using conditional logistic regression models. After adjusting for covariates, children seen by a PD were 51% more likely to have received fluoride treatment, 26% more likely to have had at least two dental examinations, and 19% more likely to have received a sealant than children seen by a GD. Overall, our results suggest that children seen by a PD were more likely to have received preventive services than those seen by a GD. Because Medicaid-enrolled children are at increased risk for poor oral health, policies should be enacted to ensure that high-risk children receive appropriate and regular prevention-oriented dental care.

Time to first dental visit after initially enrolling in Medicaid and S-SCHIP

BACKGROUND

Accessing dental care is a significant problem for children in Medicaid and S-SCHIP (Separate State Children's Health Insurance Program). Previous studies have indicated that the design of the Medicaid or S-SCHIP dental program can have an impact on the ability to use services.

OBJECTIVE

To evaluate the factors related to how quickly children had any dental visit and had a preventive dental visit after first enrolling in the Iowa Medicaid and S-SCHIP programs. The primary question was whether the structure of the dental plan was related to improved access to care.

METHODS

Iowa Medicaid and S-SCHIP dental claims and enrollment files for FY 2001 through 2003 were used to identify children who were newly enrolled in the programs and their use of dental services. Factors related to the time to a child's first dental visit were analyzed using survival analytic techniques.

RESULTS

After 6 months in the program, between 21% and 36% of children had received their first dental visit, depending on their dental plan. This increased from 39% to 56% after 1 year. Based on the survival analysis, earlier dental utilization was related to the type of plan in which the child was enrolled as well as the child's age, race, and urban/rural location.

CONCLUSIONS

Children in the S-SCHIP 2 dental plan, which had an open provider network and paid dentists' full charges, were most likely to have had a dental visit sooner after enrollment. States looking for options to improve access to dental care in their Medicaid and S-SCHIP programs should consider contracting with dental plans with these features.

Receipt of preventive dental care among special-needs children enrolled in Medicaid: a crisis in need of attention

Although not widely recognized, tooth decay is the most common childhood chronic disease among children ages five to seventeen. Despite higher rates of dental caries and greater needs, low-income minority children enrolled in Medicaid are more likely to go untreated relative to their higher income counterparts. No research has examined this issue for children with special needs. We analyzed Medicaid enrollment and claims data for special-needs children enrolled in the District of Columbia Medicaid program to evaluate receipt of recommended preventive dental care. Use of preventive dental care is abysmally low and has declined over time. Enrollment in managed care rather than fee for service improves the likelihood that special-needs children receive recommended preventive dental services, whereas residing farther from the Metro is an impediment to receipt of dental care.

Linking mother and child access to dental care

OBJECTIVES

Among young children in low-income families covered by Medicaid, we estimated (according to racial/ethnic group) whether children who have mothers with a regular source of dental care at baseline have greater dental use in the subsequent year than children with mothers without a regular source.

METHODS

From a population of 108151 children (aged 3 to 6 years) who were enrolled in Medicaid and their low-income mothers in Washington state, a disproportionate stratified random sample of 11305 children aged 3 to 6 was selected from enrollment records in 4 racial/ethnic groups: black (3791), Hispanic (2806), white (1902), and other racial/ethnic groups (2806). In a prospective cohort design, we conducted a baseline survey of mothers and for respondents collected their children's Medicaid dental claims in the 1-year follow-up period. Mutivariable regression models estimated the associations between the mothers' having a regular source of dental care at baseline and their children's prospective dental use.

RESULTS

Approximately 38% of the mothers had a regular source of dental care. Among children of black and Hispanic mothers, having a mother with a regular source of dental care at baseline was associated with greater odds of receiving any dental care in the subsequent year. For children with dental use, children of black or Hispanic mothers with a regular source of dental care received 1.22 and 1.10 more preventive services, respectively. For children of white mothers, associations were in the same direction but not significant.

CONCLUSIONS

For young children of black and Hispanic mothers, dental care use is higher when their mothers have a regular source of dental care. For low-income young children with Medicaid, increasing the mothers' access to dental care may increase the children's use of dental and preventive services, which, in turn, may reduce racial/ethnic inequalities in oral health.

Dissatisfaction with dental care among mothers of Medicaid-enrolled children

OBJECTIVES

This paper is part of a larger study examining the impact of mothers' having a regular source of dental care (RSDC) on utilization of dental care and oral health of their preschool children. We describe levels of satisfaction with care among mothers whose preschool children were enrolled in Medicaid in Washington State. We report mothers' satisfaction related to having a RSDC by type of dental setting/office.

METHODS

Disproportionate stratified sampling by racial/ethnic group selected 11 305 children aged 3-6 in Medicaid in Washington State. Mothers (n = 4373) completed a mixed-mode survey. Satisfaction with dental care was measured using the Dental Satisfaction Questionnaire (DSQ).

RESULTS

Overall mean DSQ was 57.1 +/- 9.9 (range 18-89). A higher score indicates greater satisfaction. There was not evidence of a difference in dissatisfaction by race/ethnicity but Blacks and Hispanics were less satisfied with pain management than Whites. The majority of respondents agreed with the statement that 'Dentists sometimes act rude to their patients.' Satisfaction is higher for mothers who have a regular private dentist they see consistently versus having a regular dentist through a public or non-profit clinic.

CONCLUSIONS

The satisfaction with dental care for this population is low, and considerably lower than found in other studies for primary medical care. Steps need to be taken to increase dental satisfaction and access to private dental clinics, and to increase perceived quality and pain management of dental care in both private clinics and public/non-profits serving low-income populations.

Disparities in regular source of dental care among mothers of medicaid-enrolled preschool children

For mothers of Medicaid children aged 3 to 6 years, we examined whether mothers' characteristics and local supply of dentists and public dental clinics are associated with having a regular source of dental care. Disproportionate stratified sampling by racial/ethnic group selected 11,305 children aged 3 to 6 in Medicaid in Washington State. Mothers (n=4,373) completed a mixed-mode survey that was combined with dental supply measures. Results reveal 38% of mothers had a regular dental place and 27% had a regular dentist. Dental insurance, greater education, income, length of residence, and better mental health were associated with having a regular place or dentist for Black, Hispanic, and White mothers, along with increased supply of private dentists and safety net clinics for White and Hispanic mothers. Mothers lacking a regular source of dental care may increase oral health disparities disfavoring their children.

Disparities in early childhood caries

Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.

Ohio dental care providers' treatment of young children, 2002

BACKGROUND

Adequate access to dental care for young children--particularly those from low-income families--is a public concern. The authors conducted a survey of Ohio dental care providers to examine factors influencing their willingness to care for these children.

METHODS

Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs' responses by years since graduation and geographic character.

RESULTS

Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations.

CONCLUSIONS

Children's being young (0-2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children's being enrolled in Head Start made GPs somewhat more likely to treat them.

PRACTICE IMPLICATIONS

New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.

The effectiveness and estimated costs of the Access to Baby and Child Dentistry program in Washington state

OBJECTIVES

The authors estimated the effectiveness of the Access to Baby and Child Dentistry (ABCD) program as a tool to improve the oral health of children, and they measured its costs. ABCD is an effort to increase the utilization of dental care by Medicaid-enrolled children younger than 6 years.

METHODS

The authors compared the oral health of third-grade children in Spokane County Wash. (ABCD) with that of children in Pierce County (non-ABCD). They then compared the expenditures of ABCD with those associated with alternative dental care interventions.

RESULTS

Children in Spokane County had better oral health than did the children in Pierce County. The authors also found that the ABCD program increased mean dental care costs by $8.17 per user over costs in Pierce County, and the program cost a mean of $5.33 per user in outreach and dentist and staff training costs.

CONCLUSIONS

This study found that ABCD improved the oral health of all third graders, including those not eligible or enrolled in the program. Increased expenditures were attributable mainly to outreach and training costs.

CLINICAL IMPLICATIONS

Programs such as ABCD, carried out collaboratively by component societies, health districts, dental schools and Medicaid, have the potential to increase access to care and improve health.

An ABCD program to increase access to dental care for children enrolled in Medicaid in a rural county

OBJECTIVES

The Access to Baby and Child Dentistry (ABCD) Program addresses the needs of families in obtaining dental care. In this study, the program was evaluated in rural Stevens County, Washington. Aims were to assess utilization of dental services, average dental expenditures per child, and oral health status.

METHODS

Medicaid-enrolled children aged 1-4 years were randomly assigned to the ABCD program (n=216) or to regular benefits (n=221). An outreach worker contacted each ABCD family and provided an orientation. Dental care utilization and expenditures were calculated from claims. A posttest-only design was used to evaluate oral health status.

RESULTS

An enrollment effect was seen in ABCD, but the difference between groups was not sustained. There was a doubling of utilization between groups for the youngest cohort, while the others showed no differences. In the first year the rate was higher for the entire ABCD group than for the children not in ABCD (34.0% vs 24.7%). Thirty-three percent of ABCD children (70/212) who had visited the dentist had >1 appointment compared to 21.5 percent (47/219) for the children not in ABCD who had visited the dentist. There was no overall difference in expenditures, while expenditures for preventive services were greater for ABCD. ABCD children had fewer teeth with initial caries. The average incremental cost per child per initial lesion prevented was 31.44 dollars.

CONCLUSION

ABCD most benefited the youngest cohort of children and improved health.

Evaluation of a dental society-based ABCD program in Washington state

BACKGROUND

The authors present a two-year evaluation of a dental society-managed dental care program in Washington state. A variation of the Access to Baby and Child Dentistry, or ABDC, program, the Mom & Me program was initiated to increase access to dental care for Medicaid-enrolled children younger than age 6 years in Yakima County.

METHODS

This evaluation includes enrollment and visit data, first- and second-year cost data and results of a survey conducted with dental society members.

RESULTS

The number of dentists treating Medicaid-enrolled children on a regular basis more than doubled, from 15 to 38 general dentists. In the first two years of the program, 4,705 children were enrolled and approximately 51 percent visited a dentist.

CONCLUSIONS

The responses of dentists surveyed were positive, and the authors suggest that a dental society-managed program under the ABCD program -umbrella is a unique strategy for improving access to dental care for Medicaid clients.

CLINICAL IMPLICATIONS

ABCD programs provide an avenue for dentists to treat children who otherwise would not receive care.

The dental home: a primary care oral health concept

BACKGROUND

The pediatrics community has promoted the concept of a medical home to improve families' care utilization. The authors describe the medical home and propose a dental home concept to improve families' access to dental care.

DESCRIPTION

The dental home is a locus for preventive oral health supervision and emergency care. It can be a repository for records and the focus for making specialty referrals. When culture and ethnicity are barriers to care, the dental home offers a site adapted to care delivery and is sensitive to family values.

CLINICAL IMPLICATIONS

The dental home can provide access to preventive and emergency services for children. Establishment of the home early in the child's life can expose a child to prevention and early intervention before problems occur, reduce anxiety and facilitate referral.