What outcomes are associated with early preventive dental care among Medicaid-enrolled children in Alabama

Preventive dental care provided by a dentist for children before the age of 2 enrolled in Medicaid in Alabama was associated with more frequent subsequent treatment for tooth decay, more visits and more spending on dental care compared with no early preventive dental care for children, according to an article published online by JAMA Pediatrics.

The American Academy of Pediatrics, American Dental Association and American Academy of Pediatric Dentistry recommend children see a dentist at least once before they are a year old but limited evidence supports the effectiveness of early preventive dental care or whether primary care providers can deliver it. Despite a focus on preventive dental care, dental caries (tooth decay or cavities) are on the rise in children under the age of 5.

Justin Blackburn, Ph.D., of the University of Alabama at Birmingham School of Public Health, and coauthors compared tooth decay-related treatment, visits and dental expenditures for children receiving preventive dental care from a dentist or primary care provider and those receiving no preventive dental care.

Authors analyzed Medicaid data from 19,658 children in Alabama, 25.8% of whom received preventive dental care from a dentist before age 2.

Compared with similar children without early preventive dental care, children receiving early preventive dental care from a dentist had:

• More frequent tooth decay-related treatment (20.6 percent vs. 11.3 percent)
• A higher rate of visits
• Higher annual dental expenditures ($168 vs. $87)

Preventive care delivered by primary care providers was not significantly associated with tooth decay-related treatment or expenditures, according to the results.

The study had limitations, including that it doesn't measure other benefits of preventive dental care such as improved quality of life or include information on oral health behaviors such as teeth brushing. The study also doesn't include information regarding water fluoridation.

"Adding to a limited body of literature on early preventive dental care, we observed little evidence of the benefits of this care, regardless of the provider. In fact, preventive dental care from dentists appears to increase caries-related treatment, which is surprising. Additional research among other populations and beyond administrative data may be necessary to elucidate the true effects of early preventive dental care," the study concludes.