A recent study suggests no clear benefit of early preventive dental care for reducing cavities in children.
Cavities are a sign of tooth decay, one of the most common chronic diseases among children. Tooth decay is more often seen in low socioeconomic and minority status children and is linked to loss of teeth, stunted growth, poor academic performance, and poor quality of life. Lack of access to dental care, lack of parental knowledge about cavity prevention, and low fluoride levels in drinking water all contribute to tooth decay.
Previous studies stress the importance of early preventive dental care and recommend that children have a dentist no later than their first birthday. Thus, oral care as part of regular well-child pediatric visits is becoming more common, and many Medicaid agencies have programs for primary care providers (PCPs) to provide preventive dental care. However, the number of dental cavities in children under the age of 5 has increased despite more attention on prevention. A review of current studies found only weak evidence to support claims of reduction in dental cavities as a result of early preventive dental care.
A study by Blackburn et al. published in JAMA Pediatrics, examined the effectiveness of early preventive dental care in reducing cavities in young children. The investigators conducted a retrospective study of preventive dental care in children enrolled in Medicaid at birth in Alabama from 2008-2012. Using Medicaid enrollment data along with dental claim data, investigators were able to compare outcomes of children receiving dental care within the first two years of life against those receiving no dental care before age 2. High-dimensional propensity scores were used to minimize selection bias and adjust for demographics, access to dental care, and willingness to seek health care services. Of the 19658 eligible children, 3658 (25.8%) had early preventive dental care either from a dentist or PCP. Those with dentist-provided care had an increase of 0.14 cavity-related visits per child-year and a $40.77 increase in spending compared with those receiving dental care from a PCP. The frequency of preventive dental care did not seem to have an effect on these outcomes. However, the investigators acknowledge limitations such as a lack of information on tooth brushing habits and variation in quality of care.
Despite a push for early preventive dental care, this study found little benefit in dentist or PCP-provided care. Surprisingly, dentist-provided preventive care seemed to increase cavity-related treatment. Investigators believe additional research incorporating more information outside of dental insurance data are needed.
Written By: Cindi A. Hoover, Ph.D.
