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Collie AD, Jayaraman J, Carrico C, Upshur C, Bortell E. The age and primary reason for the first dental visit in children with special health care needs. SPECIAL CARE IN DENTISTRY 2024; 44:1107-1114. [PMID: 38177065 DOI: 10.1111/scd.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
AIM To evaluate the average age and primary reason for the first dental visit among patients with special health care needs (SHCN) as well as to examine barriers related to accessing care for children with special health care needs. METHODS This is a cross-sectional survey that was distributed to caregivers of children with special health care needs (CSHCN). Study data was collected through REDCap, a secure web-based survey application. RESULTS A total of 75 caregivers participated in the survey. Only 13% of caregivers reported that their child was less than 1 by the time of their first dental visit. Nearly all reported seeing a pediatric dentist for their first visit (89%) and that it was for a routine exam and cleaning (83%). About one-third of guardians reported an experience where a dentist was unable to care for their child due to their SHCN (36%). DISCUSSION It appears that caregivers of CSHCN that participated in this survey have established routine care with a pediatric dentist at an early age. It is important to continue to educate caregivers on the importance of routine care as well as support general dentists in their role of caring for patients with SHCN.
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Affiliation(s)
| | - Jayakumar Jayaraman
- Department of Pediatric Dentistry, Virginia Commonwealth University, Richmond, USA
| | - Caroline Carrico
- Department of Dental Health and Public Policy, Virginia Commonwealth University, Richmond, USA
| | - Conway Upshur
- Department of General Practice, Virginia Commonwealth University, Richmond, USA
| | - Elizabeth Bortell
- Department of Pediatric Dentistry, Virginia Commonwealth University, Richmond, USA
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Mohamadi-Bolbanabad A, Abdullah FZ, Safari H, Rezaei S, Afkhamzadeh A, Amirhosseini S, Shadi A, Mahmoudpour J, Piroozi B. Unmet dental care need in West of Iran: determinants and inequality. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2021. [DOI: 10.1108/ijhrh-09-2020-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran.
Design/methodology/approach
A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index.
Findings
In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor.
Originality/value
This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.
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Song PH, White BA, Chisolm DJ, Berney S, Domino ME. The effect of an accountable care organization on dental care for children with disabilities. J Public Health Dent 2020; 80:244-249. [PMID: 32519336 DOI: 10.1111/jphd.12375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/19/2020] [Accepted: 05/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Accountable care organizations (ACOs) are a new model of health-care delivery that aim to improve care through increased provider collaboration and financial rewards for meeting cost and quality targets for a defined patient population. In this study, we examined a state policy change that effectively moved some children with disabilities into a Medicaid-serving pediatric ACO on dental service use. We hypothesize that ACOs' emphasis on prevention, care coordination, and reduction in emergency department use will extend to dental services. STUDY DESIGN/METHODS We used Ohio Medicaid administrative claims data for year 2011-2016 to examine changes in patterns of dental service use by Medicaid-eligible children with disabilities before and after enrolling in an ACO compared with similar children enrolled in non-ACO managed care plans. RESULTS Dental utilization is relatively low among Medicaid-eligible children with disabilities. We find that preventive dental visits increased 3.1% points (P < 0.05) from a baseline in the control group of 33.9 percent among ACO-enrolled children, especially among adolescent children, compared to similar children that were not in the ACO, representing an 11 percent increase in the rate of preventive dental visits relative to the comparison group. However, overall dental utilization did not increase for children with disabilities who were part of the ACO compared to similar children who were not in the ACO. CONCLUSIONS Access to dental care is a continuing challenge for children covered by Medicaid. ACOs that serve Medicaid children are well positioned to include dental services and could play an important role in improving access to dental care and increasing dental utilization.
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Affiliation(s)
- Paula H Song
- Department of Health Policy and Management, The Gillings School of Global Public Health and the Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Alex White
- Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deena J Chisolm
- Center for Innovation in Pediatric Practice, Health Services Research, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Sara Berney
- Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, The Gillings School of Global Public Health and the Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Finlayson TL, Chuang E, Baek JD, Seidman R. Dental Service Utilization Among Children in the Child Welfare System. Matern Child Health J 2019; 22:753-761. [PMID: 29423585 DOI: 10.1007/s10995-018-2444-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine predisposing, enabling, and need-related factors associated with dental utilization by children involved with the child welfare system (CWS). METHODS Data were analyzed from the National Survey of Child and Adolescent Well-Being (NSCAW; Wave II), a national probability sample of children (2-17 years) following a welfare assessment during 2008-2009 (n = 2806). Caregiver-reported child receipt of dental services in the past year was the outcome in weighted logistic regression models. RESULTS Two-thirds of children had a recent dental visit. Older children (OR 2.95, 95% CI 2.06,4.21 for ages 6-11; OR 2.47, CI 1.82, 3.37 for ages 12-17, compared to ages 2-5) were more likely to have visited the dentist, as were children of more educated caregivers (OR 1.68; CI 1.20, 2.36 for high school, OR 2.45; CI 1.71, 3.52 for more than high school). Children without a usual source of care (OR 0.50; CI 0.27, 0.94) and those living with non-biological parents had lower odds of a recent visit (OR 0.64; CI 0.43, 0.97). Children with dental problems were twice as likely to have a recent visit (OR 2.02; CI 1.21, 3.38), while children with unmet needs who could not afford care had lower odds of utilizing services (OR 0.28; CI 0.16, 0.46). CONCLUSIONS FOR PRACTICE Many children in the CWS, especially younger children (ages 2-5), did not have a reported dental visit in the past year. Cost was a barrier, and caregiver status was associated with the likelihood of obtaining dental care. Health and social service providers should refer these children for dental care.
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Affiliation(s)
- Tracy L Finlayson
- Health Management & Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.
| | - Emmeline Chuang
- Health Policy and Management, UCLA Fielding School of Public Health, CHS 31-254A, 650 Charles E Young Dr. South, P.O. Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Jong-Deuk Baek
- Health Management & Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Robert Seidman
- Health Management & Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
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Abstract
Children with special health care needs (CSHCN) are a vulnerable population subgroup, but little is known about their oral health, particularly regarding the prevalence and cause of tooth decay. This lack of knowledge is a barrier to progress in terms of developing evidence-based clinical interventions and policies aimed at promoting oral health in CSHCN. This article reviews the oral health literature pertaining to CSHCN, identifies critical knowledge gaps, highlights future research opportunities, and extends clinical recommendations to pediatric health care providers.
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Lee HS, Jung HI, Kim SM, Kim J, Doh RM, Lee JH. Attitudes of Korean Dental Students Toward Individuals with Special Health Care Needs. J Dent Educ 2015. [DOI: 10.1002/j.0022-0337.2015.79.9.tb05995.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Hyo-Seol Lee
- Department of Pediatric Dentistry; School of Dentistry; Yonsei University; Seoul Republic of Korea
| | - Hoi In Jung
- BK21 PLUS Project; College of Dentistry; Yonsei University; Seoul Republic of Korea
| | - Seon-Mi Kim
- Department of Pediatric Dentistry; College of Dentistry; Chonnam National University; Gwangju Republic of Korea
| | - Jiyoen Kim
- Department of Pediatric Dentistry; College of Dentistry; Pusan National University; Pusan Republic of Korea
| | - Re Mee Doh
- Department of Advanced General Dentistry; College of Dentistry; Dankook University; Cheonan Republic of Korea
| | - Jae-Ho Lee
- Department of Pediatric Dentistry; College of Dentistry; Yonsei University; Seoul Republic of Korea
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Chi DL, Masterson EE. A serial cross-sectional study of pediatric inpatient hospitalizations for non-traumatic dental conditions. J Dent Res 2013; 92:682-8. [PMID: 23694928 DOI: 10.1177/0022034513490733] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Investigators have examined children's dental utilization in various settings (e.g., dental offices, emergency departments, operating rooms), but no studies have examined inpatient hospitalizations for non-traumatic dental conditions (NTDCs). The authors examined NTDC-related hospitalization trends in the United States and identified the relationship between complex chronic condition (CCCs) and NTDC-related inpatient hospitalizations. We analyzed data from the U.S. Nationwide Inpatient Sample (2000-2010) for children ages 3 to 17 years (N = 3,030,970). The predictor variable was number of CCCs (0/1/2+). The outcome variable was whether the child had a NTDC-related hospitalization (no/yes). Covariate-adjusted multivariable logistic regression models were used to estimate prevalence odds ratios (PORs). From 2000 to 2010, there were 17,993 NTDC-related hospitalizations (0.59%) and a slight increase in NTDC-related hospitalizations (p = .049). This increase was not significant in the final regression model. There was no difference in odds of NTDCs for children with 0 or 1 CCCs (POR = 1.08; 95%CI = 0.99, 1.18), but children with 2+ CCCs had significantly greater odds (POR = 1.61; 95%CI = 1.42, 1.83), as did non-White, publicly insured, and lower income children. NTDC-related hospitalizations for children did not increase from 2000 to 2010. Children with 2+ CCCs had the greatest odds of being hospitalized for NTDCs, which highlights the need to develop preventive interventions targeting children with 2+ CCCs.
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Affiliation(s)
- D L Chi
- University of Washington, Seattle, WA, USA.
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Leroy R, Declerck D. Oral health-care utilization in adults with disabilities in Belgium. Eur J Oral Sci 2012; 121:36-42. [PMID: 23331422 DOI: 10.1111/eos.12015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.
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Affiliation(s)
- Roos Leroy
- Department of Oral Health Sciences, Oral Health Research Unit, KU Leuven, Leuven, Belgium.
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Leroy R, Declerck D. Oral health care utilization in children with disabilities. Clin Oral Investig 2012; 17:1855-61. [PMID: 23135426 DOI: 10.1007/s00784-012-0874-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 10/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this report were to survey the utilization of oral health care in children and adolescents with disabilities over a 7-year period and to compare these data with the utilization pattern of their peers without disabilities. For most countries, these data have not been published in the international literature so far. MATERIAL AND METHODS The cohort used was the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents. The database comprised prospective data on oral and general health care utilization and sociodemographic variables collected from 2002 up to 2008. RESULTS Data were available from 326 children and adolescents with and 53,589 without disabilities. Dental attendance rates were low in both subgroups: only 50 % had a dental visit in four or more of the seven observation years. Emergency oral and medical care was recorded significantly more often in children with disabilities whereas radiographs, restorations, and orthodontic assessments and treatments more frequently in children without disabilities. CONCLUSION The present study demonstrated that dental attendance rates in both subgroups were low and that in those who attended, preventive oral health care was only infrequently attested. Further research is needed to elucidate whether the lower number of radiographs and restorations and the higher number of emergency visits observed in the subgroup with disabilities reflect unmet oral treatment needs. CLINICAL RELEVANCE Objective data on health care utilization are essential to enable governments and stakeholders to devise appropriate care and to optimize access to care for persons with disabilities.
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Affiliation(s)
- Roos Leroy
- Department of Oral Health Sciences, Oral Health Research Unit, KU Leuven, Kapucijnenvoer 7 blok a bus 7001, 3000, Leuven, Belgium,
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Health care use and expenditures associated with access to the medical home for children and youth. Med Care 2012; 50:262-9. [PMID: 22228246 DOI: 10.1097/mlr.0b013e318244d345] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model. OBJECTIVE To test associations between having a medical home and health service use and expenditures among US children and youth. RESEARCH DESIGN Observational cross-sectional study. SUBJECTS A total of 26,221 children aged 0 to 17 years surveyed in the 2005 to 2007 Medical Expenditure Panel Surveys. MEASURES Parent report of a child's access to a medical home was developed from multiple survey items in the Medical Expenditure Panel Surveys. Negative binomial regression examined the association between the medical home and parent-reported counts of annual outpatient, inpatient, emergency department, and dental visits. Two-part models examined associations between the medical home and parent-reported annual total, outpatient, inpatient, emergency department, and other health care expenditures. Models accounted for potential self-selection into a medical home using propensity scores. RESULTS Children with a medical home had a greater incidence of preventive visits [incidence rate ratio (IRR)=1.11; (95% confidence intervals (CI), 1.03-1.20)] and dental visits [IRR=1.09 (95% CI, 1.02-1.17)] and a lower incidence of emergency department visits [IRR=0.87 (95% CI, 0.79-0.97)] compared with children without a medical home. Children with a medical home also had greater odds of incurring total, outpatient, prescription medication, and dental expenditures, OR's ranging from 1.09 to 1.38. Despite greater odds of incurring certain expenditures, expenditures were no different for children with and without a medical home. CONCLUSIONS The medical home is associated with several domains of health service use, yet there is no evidence for its association with health care expenditures for children and youth.
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Oral Health Need and Access to Dental Services: Evidence from the National Survey of Children’s Health, 2007. Matern Child Health J 2012; 16 Suppl 1:S27-34. [DOI: 10.1007/s10995-012-0992-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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DeMattei RR, Allen J, Goss B. A Service-Learning Project to Eliminate Barriers to Oral Care for Children With Special Health Care Needs. J Sch Nurs 2012; 28:168-74. [PMID: 22215649 DOI: 10.1177/1059840511432473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.
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Affiliation(s)
| | - Jessica Allen
- Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Breanna Goss
- Southern Illinois University Carbondale, Carbondale, IL, USA
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Iida H, Lewis CW. Utility of a Summative Scale Based on the Children with Special Health Care Needs (CSHCN) Screener to Identify CSHCN with Special Dental Care Needs. Matern Child Health J 2011; 16:1164-72. [DOI: 10.1007/s10995-011-0894-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Chi DL, Momany ET, Neff J, Jones MP, Warren JJ, Slayton RL, Weber-Gasparoni K, Damiano PC. Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Med Care 2011; 49:180-92. [PMID: 21150799 PMCID: PMC3095041 DOI: 10.1097/mlr.0b013e3181f81c16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. OBJECTIVE To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. RESEARCH DESIGN Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). SUBJECTS Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. MEASURES The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. RESULTS After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%-6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). CONCLUSIONS There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.
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Affiliation(s)
- Donald L Chi
- Department of Dental Public Health Sciences, School of Dentistry, The University of Washington, Seattle, WA 98185, USA.
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Beil HA, Rozier RG. Primary health care providers' advice for a dental checkup and dental use in children. Pediatrics 2010; 126:e435-41. [PMID: 20660547 DOI: 10.1542/peds.2009-2311] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In this study we estimated factors associated with children being advised to see the dentist by a doctor or other health provider; tested for an association between the advisement on the likelihood that the child would visit the dentist; and estimated the effect of the advisement on dental costs. METHODS We identified a sample of 5268 children aged 2 to 11 years in the 2004 Medical Expenditures Panel Survey. A cross-sectional analysis with logistic regression models was conducted to estimate the likelihood of the child receiving a recommendation for a dental checkup, and to determine its effect on the likelihood of having a dental visit. Differences in cost for children who received a recommendation were assessed by using a linear regression model. All analyses were conducted separately on children aged 2 to 5 (n = 2031) and aged 6 to 11 (n = 3237) years. RESULTS Forty-seven percent of 2- to 5-year-olds and 37% of 6- to 11-year-olds had been advised to see the dentist. Children aged 2 to 5 who received a recommendation were more likely to have a dental visit (odds ratio: 2.89 [95% confidence interval: 2.16-3.87]), but no difference was observed among older children. Advice had no effect on dental costs in either age group. CONCLUSIONS Health providers' recommendation that pediatric patients visit the dentist was associated with an increase in dental visits among young children. Providers have the potential to play an important role in establishing a dental home for children at an early age. Future research should examine potential interventions to increase effective dental referrals by health providers.
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Affiliation(s)
- Heather A Beil
- Department of Health Policy and Management, UNC Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA.
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