A number of studies have examined dental utilization for Medicaid-enrolled children (Dubay and Kenney 2001
; Lee and Horan 2001
; Macek, Edelstein, and Manski 2001
; Slayton, Damiano, and Willard 2001
; Savage et al. 2004
;). Fewer investigations have evaluated dental utilization for children after they are initially enrolled in Medicaid (Damiano et al. 2008
; Chi et al. 2010
;). Findings from these latter studies suggest that subgroups of newly Medicaid-enrolled children, including those identified with an intellectual and/or developmental disability (IDD), have significantly later first Medicaid dental visits. Children identified with an IDD are part of a larger group of children with chronic conditions (CCs), which are defined as conditions lasting ≥12 months in 75 percent of identified cases (Muldoon, Neff, and Gay 1997
). While dental care is the most common unmet health care need for children with a CC (Newacheck et al. 2000
; Lewis, Robertson, and Phelps 2005
;), there is limited knowledge on (a) the impact of having a CC on how soon after enrolling in Medicaid children visit a dentist; and (b) the impact of CC severity on how soon newly Medicaid-enrolled children visit a dentist. This lack of knowledge is a critical barrier in the development of population-based interventions and policies aimed at improving dental utilization for children who are newly enrolled in Medicaid. The purpose of this study was to identify the determinants of how soon newly Medicaid-enrolled children visited a dentist, with an emphasis on the relationship between CC status and severity, respectively, and the time to first Medicaid dental visit.
In addition to drinking fluoridated water, regular toothbrushing with fluoridated toothpaste, and a diet low in fermentable carbohydrates, first Medicaid dental visits can help to prevent dental caries, the most common childhood disease in the United States (U.S. Department of Health and Human Services 2000
). Earlier first Medicaid dental visits enable children to benefit from preventive treatments such as topical fluoride and dental sealants (Bhuridej et al. 2007
; Azarpazhooh and Main 2008a
). During these visits, dentists are also able to assess a child's future risk of developing caries; provide caregivers with risk-based anticipatory guidance; and detect incipient disease (Nowak and Casamassimo 1995
; Sanchez and Childers 2000
; Hale and American Academy of Pediatric Section on Pediatric Dentistry 2003
; American Academy of Pediatric Dentistry Council on Clinical Affairs 2005–2006
;). In addition, first Medicaid dental visits are a starting point for subsequent episodes of dental care. While the evidence is anecdotal, these episodes of care typically consist of preventive care and periodic checkups for children with no dental disease and no need for restorative care (e.g., dental fillings, crowns, tooth extractions) and checkups for children with dental disease. There is also a proportion of children with treatment needs who do not return to the dentist after the first Medicaid dental visit. These observations suggest that first Medicaid dental visits are only part of the solution in improving the long-term oral health of Medicaid-enrolled children.
As many as one in three children in the United States has a CC (Kuhlthau et al. 2002
). Children with a CC are at increased risk for poor oral health because of long-term use of prescription medications that contain sugar (Feigal, Jensen, and Mensing 1981
) or alter saliva production (Keene, Galasko, and Land 2003
); behavioral comorbidities that make it hard for caregivers to provide regular oral hygiene (Ferguson and Cinotti 2009
) or dentists to provide necessary care in an office setting; and reluctance on the part of dentists to treat children with special needs because of inadequate training (Casamassimo, Seale, and Ruehs 2004
). Furthermore, over 70 percent of children with a CC are enrolled in state Medicaid dental programs (Kaiser Commission on Medicaid and the Uninsured 2007
), which introduces additional program-related barriers to dental utilization (Lam, Riedy, and Milgrom 1999
; Iben, Kanellis, and Warren 2000
; Mayer et al. 2000
; Nainar 2000
; Al Agili et al. 2004
; Al Agili et al. 2007
Delayed first Medicaid dental visits may explain, in part, why subgroups of newly Medicaid-enrolled children are at increased risk for oral health disparities. While children with a CC share characteristics that make them less likely to visit a dentist shortly after enrolling in Medicaid, there is currently no empirical support for this hypothesis. In this study, we evaluated the determinants of how soon a child visited a dentist after initially enrolling in Medicaid. Our primary interest was the relationship between CC status (no/yes) and CC severity (less severe/more severe), respectively, and how soon a child saw a dentist for the first time after enrolling in the Iowa Medicaid Program. We used enrollee-level administrative data to test the following hypotheses:
- There is no difference in the rates at which children with and without a CC visit a dentist for the first time after enrolling in Medicaid.
- Among children with a CC, there is no difference in the rates at which children visit a dentist for the first time after enrolling in Medicaid by CC severity.
This work is a continuation of efforts to identify potential reasons why subgroups of Medicaid-enrolled children tend to have poor oral health. Our findings will be used to develop future research as well as clinical interventions and policies that seek to improve dental utilization for newly Medicaid-enrolled children.