Effects of Physician-Based Preventive Oral Health Services on Dental Caries

Abstract

Background: Most Medicaid programs reimburse nondental providers for preventive dental services. We estimate the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students, hypothesizing improved oral health among students with medical visits with POHS.

Methods: We conducted a retrospective study in 29,173 kindergarten students by linking Medicaid claims (1999-2006) with public health surveillance data (2005-2006). Zero-inflated regression models estimated the association between number of visits with POHS and (1) decayed, missing, and filled primary teeth (dmft) and (2) untreated decayed teeth while adjusting for confounding.

Results: Kindergarten students with ≥4 POHS visits averaged an adjusted 1.82 dmft (95% confidence interval: 1.55 to 2.09), which was significantly less than students with 0 visits (2.21 dmft; 95% confidence interval: 2.16 to 2.25). The mean number of untreated decayed teeth was not reduced for students with ≥4 POHS visits compared with those with 0 visits.

Conclusions: POHS provided by nondental providers in medical settings were associated with a reduction in caries experience in young children but were not associated with improvement in subsequent use of treatment services in dental settings. Efforts to promote oral health in medical settings should continue. Strategies to promote physician-dentist collaborations are needed to improve continuity of care for children receiving dental services in medical settings.

FIGURE 1

Predicted mean number of dfmt according to number of visits. Wald tests were used to examine differences in predicted dmft compared with 0 visits: *P < .05, **P < .001. Error bars represent 95% confidence intervals.

FIGURE 2

Predicted mean number of dt according to number of visits. Wald tests were used to examine differences in predicted dt compared with 0 visits: *P < .05, **P < .001. Error bars represent 95% confidence intervals.