Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees

Abstract

Objective: To estimate the effectiveness of a medical office-based preventive dental program (Into the Mouths of Babes [IMB]), which included fluoride varnish application, in reducing treatments related to dental caries.

Methods: We used longitudinal claims and enrollment data for all children aged 72 months or younger enrolled in North Carolina Medicaid from 2000 through 2006. Regression analyses compared subgroups of children who received up to 6 IMB visits at ages 6 to 35 months with children who received no IMB visits. Analyses were adjusted for child and area characteristics.

Results: Children enrolled in North Carolina Medicaid with ≥ 4 IMB visits experienced, on average, a 17% reduction in dental-caries-related treatments up to 6 years of age compared with children with no IMB visits. When we simulated data for initial IMB visits at 12 and 15 months of age, there was a cumulative 49% reduction in caries-related treatments at 17 months of age. The cumulative effectiveness declined because of an increase in treatments from 24 to 36 months, an increase in referrals for dental caries occurred with increasing time since fluoride application, and emergence of teeth not initially treated with fluoride.

Conclusions: North Carolina's IMB program was effective in reducing caries-related treatments for children with ≥ 4 IMB visits. Multiple applications of fluoride at the time of primary tooth emergence seem to be most beneficial. Referrals to dentists for treatment of existing disease detected by physicians during IMB implementation limited the cumulative reductions in caries-related treatments, but also contributed to improved oral health.

FIGURE 1

IMB frequency according to child's age.

FIGURE 2

Annual medical and dental utilization for Medicaid-eligible children ages 6 to 72 months.

FIGURE 3

Simulated reduction in caries with IMB treatment at ages 12, 15, 18, 24, and 35 months. CI indicates confidence interval.

FIGURE 4

Simulated cumulative effect of IMB visits on caries-related treatment at each age based on the assumption of 0 IMB visits versus visits at ages 12, 15, 18, 24, and 35 months.