Effect of early preventive dental care on dental treatment, expenditures, and oral health among Medicaid enrolled children

Dental decay is the most prevalent chronic disease of childhood and dental care is the number one unmet healthcare need. Professional organizations are aggressively promoting a preventive dental visit by age one, but there is not strong evidence on effectiveness of early preventive dental care. The three studies in this dissertation examine the effects of the timing of a first preventive visit. The first two studies relied on data from NC Medicaid claims (1999 - 2006) and an oral health surveillance dataset to compare dental treatment, expenditures and disease status of children who had an early preventive dental visit to children who had preventive visits at older ages. The third study used a simulation model to examine the effects of alternative Medicaid policy options for the timing of the first preventive visit. We found that children who had a preventive visit by age 18 months had fewer treatments and lower expenditures than children who had a first preventive visit at age 25-36 months, but children who had a first preventive visit at age 49-60 months had less treatment than children with a visit by age 18 months. Our results indicated that children who had early preventive visits were at higher risk for disease at a very young age than children who had visits at older ages; however, they had no difference in their disease status at age five years. Further, when we expanded the definition of a preventive visit to include children who had worse oral health, children with an early preventive visit had fewer treatments and lower expenditures than children who had preventive visits at older ages. Taken together, these findings indicate that early preventive visits may be effective among children at an elevated risk for disease. The third study also found that targeting children at high risk for the age one visit was the optimal policy. These findings support the policy to promote early visits among children at higher risk for disease and allow other children to delay first visit until age three years, particularly when the supply of dentists is limited