Referrals for dental care in a medical office-based preventive dental program

Preschool age children from low-income families in North Carolina are experiencing an increase in tooth decay and have poor dental care access. In response, the NC Medicaid program began reimbursing primary care medical practitioners to provide preventive oral health services as part of an innovative program known as Into the Mouths of Babes (IMB). Since 2000, IMB participating providers are reimbursed for providing: 1. oral health screening, risk assessment and needed referrals to dentists; 2. parent counseling about infant oral health; and 3. topical fluoride therapy for the child's teeth. The three studies in this dissertation examined the risk assessment and referral component of IMB. The first and second studies assess the predictors and effectiveness of physicians' referral recommendations. They use a dataset (2000-02) that combines Medicaid claims for IMB, and medical and dental visits with physician-completed child oral health risk assessment forms that contain information on child oral health status. The third study is an intent-to-treat analysis that compares time to use of dental care for children receiving well-child care in practices participating in IMB compared to non-participating practices. The data for this study are Medicaid claims from 2004-2006. Results from the first two studies indicate that physician referrals facilitate use of dental care by children receiving the referrals. However, physicians tend to under-refer and their referrals result in dental visits for only a small proportion of children who need dental care. We conclude that increased emphasis is needed on training pediatric primary care providers to identify children most in need of dental care and in developing systems and processes that are likely to enable providers to help children in gaining access to needed dental services. The third study provides initial evidence that practice participation in IMB reduces dental visit rates for children seen for well-child care in IMB practices compared to practices that never participated in IMB. The conclusion is that we were better able to detect the effect of oral preventive services provided as part of IMB than any effect from the dental screening services, which needs further study