Tuesday, September 5, 2017

Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs


Resident’s Name:            Carol Caudill                                                                           Date: 9/6/17
Article Title: Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs
Author(s): Savage, Lee, Kotch, Vann
Journal: Pediatrics
Date: 2004
Major Topic: preventive dental visits
Type of Article:  longitudinal cohort study
Main Purpose: To determine the effects of early preventive dental visits on utilization and costs of dental services in preschool-aged children
Key Points: (2 lines Max): Children who had an early preventive dental visit were more likely to have subsequent preventive visits and have lower dentally related costs

Introduction
·      19% of children aged 24 to 60 months have ECC. However, in low income families is much more prevalent. Prevalence of 90% in 3-5 year olds in Head Start
·      Children 2-5 years old living at or below the federal poverty level have almost 80% of decayed primary teeth not restored
·      Anticipatory guidance: the process of providing practical, developmentally appropriate information about children’s health to prepare parents for significant physical, emotional, and psychological milestones
·      Recommendations: first dental risk assessment by 6 months of age and establishment of a dental home by one year of age. First dental visit should be no later than 12 months of age.
·      Goal: use early invention to help reduce or eliminate future dental caries. Secondary goal: decrease need for costly dental treatment
Methods
·      5-year retrospective cohort study of Medicaid-enrolled children born in North Carolina in 1992
·      Looked at claims filed through Medicaid and categorized them as preventive, restorative, or emergency. Also looked at dentally related costs.
Results
·      Study examined 9,204 children continuously enrolled in Medicaid during the 5 year period
·      One third of the children had a dental visit during the study period
·      27% of the children had their first preventive dental visit before age 5, 18% had at least 1 restorative visit before age 5, 14% had at least 1 emergency visit before age 5
·      Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but not more likely to have subsequent restorative or emergency visits.
·      Children who had their first preventive dental visit between 2 and 3 years of age were more likely to have subsequent preventive visits, but were also more likely to have subsequent restorative and emergency visits
·      Minority children were less likely to have subsequent preventive, restorative, or emergency visits
·      Children from counties with more dental providers were more likely to have subsequent dental visits of all types
·      Average dentally related cost for each child during the 5 years of the study: $147 per child. When looking at only children who used dental services: $447 per child during the study period
·      Dentally related costs: First preventive dental visit before age 1: $262
Dentally related costs: First preventive dental visit 1-2 years old: $340
Dentally related costs: First preventive dental visit 2-3 years old: $450
Dentally related costs: First preventive dental visit 3-4 years old: $492
Dentally related costs: First preventive dental visit 4-5 years old: $547
Discussion
·      In counties with fewer dental providers there was less use of dental services suggesting a lack of access to care
·      Lower utilization of dental services by minority children on Medicaid may be due to lack of transportation, limited appointment availability, or because they feel less comfortable going to a dental provider that is not their own race
·      Why children who had their first preventive dental visit before age 1 were not more likely to have subsequent restorative or emergency visits
1.     Children who were examined by age 1 were the children of parents who were the most motivated to provide the best possible oral health care for their children
2.     Oral health anticipatory guidance led to early parental education and intervention leading to improved health outcomes and reduced costs

Remarks:
1- Only one third of the sample had a dental visit during the 5 year study period
2-
Assessment of Article:  Level of Evidence/Comments: Level II-2, cohort study

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