Effects of early preventive dental care in Medicaid-enrolled children: Greater costs

The American Academy of Pediatrics, American Dental Association and American Academy of Pediatric Dentistry recommend children see a dentist once baby teeth begin to come in; but limited evidence is available about the effectiveness of early preventive dental care or whether primary care providers can deliver it. Despite the focus on preventive dental care, dental caries, such as tooth decay or cavities, are on the rise in children under the age of 5.

The study, published in JAMA Pediatrics, 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 percent 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 versus 11.3 percent), a higher rate of visits and higher annual dental expenditures ($168 versus $87).

Preventive care delivered by primary care providers was not significantly associated with tooth decay-related treatment or expenditures, according to the results. "This study highlights the need for continued careful evaluation of the evidence basis for clinical recommendations," said Justin Blackburn, Ph.D., assistant professor in the Department of Health Care Organization and Policy at UAB. "What we find is that we cannot definitively say whether early preventive dental visits reduce tooth decay with the available data."

The study had limitations, including that it did not 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 did not 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 concluded.