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Science in the News

Context for the Alabama Early Preventive Dental Care Study

February 27, 2017 There is common agreement that important oral health outcomes for children include the maintenance of primary dentition as well as minimizing the need for caries-related treatment. A recent retrospective cohort study of 9,008 Medicaid enrolled children in Alabama examined medical claims data to investigate whether children who had oral evaluations or preventative dental care from primary care physicians or dentists had different rates of caries-related treatment or expenditures from children who received no preventive dental care in their first 2 years.1 In place of randomization, high-dimensional propensity score matching was used to reduce confounding and reduce selection bias. Medicaid-enrolled children who received preventative care were matched to those without on sex, race/ethnicity, birth year, preventive-care seeking behavior, rural-urban status, supply of dentists accepting Medicaid in each county, and county. Then the proportions of caries-related treatment and expenditures were compared for children who had or had not received oral evaluations or preventative care.

At first glance, the data presented by Blackburn et al.1 suggest that early preventive care from dentists was associated with increased caries-related treatment.  However, it is interesting to note that while most children see a primary care provider numerous times before their first birthday, only a small percentage of one-year-olds see a dentist.2  Although they used propensity score matching, this does not eliminate the chance that the children taken to see a dentist may have differed in some important way from the other children studied.  One possibility is that they may have had more overt caries disease to begin with. This would partially explain their subsequently greater caries-related visits and expenses.

Caries risk is multifactorial and has been found to include the presence of previous caries disease, environmental factors such as diet, oral home care, and exposure to fluoride, as well as barriers to care.3  It is not known how the various clinicians providing preventive dental services1 compared with respect to their ability to help those caring for the children in the study address the modifiable factors affecting caries risk.  Familiarity and access to resources to address the social determinants affecting caries risk and subsequent need for treatment is another variable which could contribute to the observed outcome.

This well conducted study highlights the important issue of best practices to reduce caries risk among underserved populations.  This is a significant public health issue and hopefully this paper strengthens recognition of the need for randomized clinical trials to generate the data needed to determine best practices.

References

  1. Blackburn J, Morrisey MA, Sen B. Outcomes Associated with Early Preventive Dental Care Among Medicaid-Enrolled Children in Alabama. JAMA Pediatrics 2017.
  2. Tang SS. Profile of Pediatric Visit: Annualized Estimates. Elk Grove Village, Illinois: American Academy of Pediatrics 2010.
  3. Featherstone JD. The caries balance: contributing factors and early detection. J Calif Dent Assoc 2003;31(2):129-33.

Prepared by: Center for Scientific Information, ADA Science Institute

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