1. This retrospective study of Medicaid-enrolled children found that nearly half had at least 1 decayed, missing, or filled tooth by kindergarten.
2. There was a statistically significant reduction in the incidence of decayed, missing, or filled teeth in children who had ≥4 primary care visits with comprehensive preventative oral health services.
Evidence Rating Level: 2 (Good)
Study Rundown: Poor access to dental care has contributed to an increasing incidence of dental caries in preschool-aged children. This retrospective study sought to examine the impact of comprehensive preventative oral health services (POHS) provided by medical professionals, as most children have more pediatrician visits than dentist visits early in life. Comprehensive POHS included oral health counseling, screening, caries risk assessment, and fluoride varnish application. Compared to children who had 0 visits with comprehensive POHS, children with ≥4 visits had 17.7% fewer decayed, missing, and filled teeth. This study is limited by its retrospective nature and the use of 1 Medicaid billing code for a bundled set of POHS, which precludes authors from ascertaining exactly which services were offered at each visit. Nonetheless, these findings highlight the importance of non-dental providers, such as primary care physicians, in reducing early childhood caries, especially before children are able to establish a dental home.
In-Depth [retrospective cohort study]: A total of 29 173 kindergarten students in North Carolina were included in the study using Medicaid claims and public health surveillance data. Among the participants, 41.5% were black, 41.3% were white, and 8.6% were Hispanic. The children had a mean 3.5 ± 2 well-child visits before the age of 3. Overall, 47.9% of children had at least 1 decayed, missing, or filled tooth by the time they entered kindergarten. Children with ≥4 visits with POHS had an adjusted average of 1.82 (95% CI 1.55-2.09) decayed, missing, or filled teeth compared to 2.21 (95% CI 2.16-2.25) decayed, missing, or filled teeth among children with 0 visits. By kindergarten, 25.3% of children had an untreated decayed tooth; however, there was no significant difference in the average number of untreated decayed teeth in children with more visits with POHS.
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