Study finds low-income children benefit from preventive oral health services

July 2, 2015

Oral health services, delivered by primary care clinicians and designed to prevent dental caries (cavities) in young children, can improve the oral health of kindergartners enrolled in Medicaid, according to a new study by three researchers affiliated with The University of North Carolina at Chapel Hill’s Gillings School of Global Public Health. However, more effort is required, the study finds, to coordinate services between medical and dental practitioners so that the children’s improved oral health care can be continued over time.

Dr. Ashley Kranz

Dr. Gary Rozier

Led by Ashley Kranz, PhD, 2013 UNC Gillings School of Global Public Health alumna and adjunct assistant professor of pediatric dentistry at UNC, the research was published online June 29 in the journal Pediatrics.

“Evidence has accumulated, particularly from studies in North Carolina, that offering services in the medical office increases access to recommended preventive dental services for young children and reduces needed treatment for tooth decay and its associated costs,” said Gary R. Rozier, DDS, research professor of health policy and management at the Gillings School and study co-author. “This study provides the first direct evidence that physician-based services will reduce tooth decay and thus improve the oral health status of children entering kindergarten.”

Poor access to oral health care – both geographical and financial – has led to significant health disparities among children of preschool age in N.C. At the turn of the 21st century, nearly 40 percent of children entering kindergarten in the state had a history of early childhood tooth decay, with rates as high as 67 percent in some counties. In 2000, the N.C. Medicaid program established the “Into the Mouths of Babes” initiative, and the high rates of dental disease in low-income children were remedied significantly through the training of physicians and nurses to screen for dental caries, counsel parents about oral health and apply fluoride varnish to young children’s teeth.

Still, in 2009 and 2010, one of four children between the ages of three and five years living in poverty had untreated caries, two-and-one-half times that of other children.

Through collaborations with the N.C. dental public health and Medicaid programs, the authors accessed data for 29,173 N.C. kindergarten students and associated the number of preschool preventive oral health visits in medical offices with the occurrence of decayed, missing or filled primary teeth.

Children who had four or more medical visits with comprehensive oral health services before their third birthdays experienced fewer cavities than those who did not receive the services. However, this group and the group with no oral health services experienced the same rate of untreated decayed teeth when they were screened in kindergarten, indicating the need for care by a dentist.

This finding led Kranz and colleagues to call for an increase in the number of preventive oral health care visits to allow the families of young children more time to establish a relationship with a dentist. Currently, Medicaid preventive oral health benefits in medical offices ends at 42 months of age. These services already should occur at well-child visits scheduled at 6, 9, 12, 15, 18, 24 and 36 months of age and typically include the application of fluoride varnish, an effective preventive measure.

The authors also noted the need to implement strategies to improve the quality and consistency of preventive oral health services within medical practices and to coordinate care between medical and dental offices.

“Screening and referral [to dentists] are important components of oral health services in medical settings,” they write, “but their effectiveness depends upon the successful completion of a number of steps in a complex and often challenging process.” That process includes being able to identify the child’s risk, disease status and need for referral, as well as helping the parent or guardian navigate the dental care system.

“Infants and toddlers enrolled in Medicaid are at high risk of developing tooth decay, yet infrequently have dental visits,” Kranz said. “Physician-based preventive oral health services can help to improve oral health for this high-risk population by delivering care in a convenient medical setting. Our findings are important as it is becomes increasingly common nationally for pediatricians to provide preventive oral health services in medical offices.”

John S. Preisser Jr., PhD, research professor of biostatistics at the Gillings School, is also a study co-author.