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Effect of Early Preventive Dental Visits on Subsequent Dental Treatment and Expenditures

Beil, Heather PhD, MPH*; Rozier, Richard Gary DDS, MPH; Preisser, John S. PhD; Stearns, Sally C. PhD; Lee, Jessica Y. DDS, MPH, PhD†,§

doi: 10.1097/MLR.0b013e3182551713
Original Articles

Objective: Professional organizations recommend a preventive dental visit by 1 year of age. This study compared dental treatment and expenditures for Medicaid children who have a preventive visit before the age of 18 months with those who have a visit at age 18–42 months.

Methods: This retrospective cohort study used reimbursement claims for 19,888 children enrolled in North Carolina Medicaid (1999–2006). We compared the number of dental treatment procedures at age 43–72 months for children who had a visit by age 18 months with children who had a visit at ages 18–24, 25–30, 31–36, and 37–42 months using a zero-inflated negative binomial model. The likelihood and amount of expenditures at age 43–72 months were compared by group using a logit and ordinary least squares regression.

Results: Children who had a primary or secondary preventive visit by age 18 months had no difference in subsequent dental outcomes compared with children in older age categories. Among children with existing disease, those who had a tertiary preventive visit by age 18 months had lower rates of subsequent treatment [18–24 mo incidence density ratio (IDR): 1.19, 95% confidence interval (CI), 1.03–1.38; 25–30 mo IDR: 1.21, 95% CI, 1.06–1.39; 37–42 mo IDR: 1.39, 95% CI, 1.22–1.59] and lower treatment expenditures compared with children in older age categories.

Conclusions: In this sample of preventive dental users in Medicaid, we found that children at highest risk of dental disease benefited from a visit before the age of 18 months, but most children could delay their first visit until the age of 3 years without an effect on subsequent dental outcomes.

*School of Nursing, University of North Carolina at Chapel Hill

Department of Health Policy and Management

Department of Biostatistics, Gillings School of Global Public Health

§Department of Pediatric Dentistry, School of Dentistry, Chapel Hill, NC

Supported by Grant No. 1R36HS018076-01 from the Agency for Healthcare Research and Quality (AHRQ). Funding for the acquisition of the data used in this paper was provided by Grant No. R01 DE013949 and Grant No. R03 DE017350, both from the National Institute of Dental and Craniofacial Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, NIDCR, or the National Institutes of Health (NIH).

The authors declare no conflict of interest.

Reprints: Heather Beil, PhD, MPH, School of Nursing, University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, NC 27599-7590. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.