This is the first published study comparing the time to first DRV for newly Medicaid-enrolled children with and without an intellectual or developmental disability (IDD). Timely DRVs are important, especially for children at risk for oral health problems, because dentists can intervene with regular preventive care and less invasive restorative treatments when necessary. During DRVs, caregivers of these children are supposed to receive anticipatory guidance, which reinforces positive oral health care practices that can benefit their children. We hypothesized that newly Medicaid-enrolled children with an IDD would have later first DRVs than children without IDD. However, our regression model results revealed no significant difference in the time to first DRV by IDD status. The only factor that was significantly related to earlier first DRVs was the time to the first comprehensive dental visit after enrolling into the Medicaid program. Children with a first comprehensive dental visit >12 months after enrolling into Medicaid were 1.68 times as likely to have an earlier first DRV as children with a first comprehensive dental visit <4 months of enrollment.
While not directly comparable, a previous study on dental recall rates reported that 64% of patients ages 2–46 (mean age 14.2 years) with a handicap such as mental retardation, cerebral palsy, epilepsy, or an orthopedic problem had a recall within 12 months (Maurer et al., 1996
). This is about 13% less than the proportion of children in our study with a dental recall within 12 months (77%). In addition, 55.3% of newly Medicaid-enrolled children ages 3–8 in our study had a comprehensive dental visit followed by a RDV (2,982/5,391) whereas 12.6% of Medicaid-enrolled children <21 years in New Hampshire received two dental examinations (Chi & Milgrom, 2009
). There are no other published studies in the literature to which we can compare our findings on first DRV rates for newly Medicaid-enrolled children by IDD status.
We have three potential explanations of our failure to detect a difference in the time to first DRVs for Medicaid-enrolled children by IDD status. First, it may be that once a newly Medicaid-enrolled child sees a dentist for the first time and is not referred to another dentist, two traits shared by children in this study, IDD status is a less important determinant of the timing of subsequent DRVs. Second, 41% of children identified with an IDD were classified as healthy, a relatively large subgroup of children who may be similar to those without IDD. Dental utilization for these children could have skewed the outcome measure for children with an IDD toward unity. However, we reanalyzed our data after excluding these healthy children with an IDD and found that the adjusted hazard ratios remained the same, making this explanation unlikely. Third, while the difference was not statistically significant, 7.7% of children with an IDD received restorative treatment between the first comprehensive dental visit and the first DRV compared to 14.8% of children without IDD (). This suggests that children with an IDD in our study had less need for restorative care, in which case we would expect to similar rates of first DRVs by IDD status.