Research examines effects of early preventive dental care in Medicaid-enrolled children

Contrary to prevailing wisdom, preventive visits to a dentist for children under 2 years old may not reduce the need for more care later, at least among those children enrolled in Medicaid in Alabama, according to a study published in the journal JAMA Pediatrics.

Early preventive dental care was associated with more frequent subsequent treatment for tooth decay, more visits and more spending on dental care, compared with no early preventive dental care.

Preventive care delivered by primary care providers was not significantly associated with tooth decay-related treatment or expenditures, according to the study.

“We don’t think that going to the dentist is somehow causing these kids to have tooth decay,” said Michael Morrisey, PhD, professor and head of the Department of Health Policy & Management at the Texas A&M School of Public Health and one of the authors of the study. “At the same time, we want parents to know that early checkups probably won’t reduce the need for future dental procedures like filings.”

The American Academy of Pediatrics, American Dental Association and American Academy of Pediatric Dentistry recommend children receive dental care once baby teeth begin to appear.

The research team, which also included Justin Blackburn, PhD, and Bisakha Sen, PhD, of the University of Alabama at Birmingham (UAB) School of Public Health, analyzed Medicaid data from 19,658 children in Alabama, 25.8 percent of whom received preventive dental care from a dentist before age 2. The average follow-up time was almost four years.

Compared with similar children without early preventive dental care, those receiving such care from a dentist had more frequent tooth decay-related treatment (20.6 percent versus 11.3 percent) and a higher rate of visits and higher annual dental expenditures ($168 versus $87) later in childhood.

However, the study authors stressed that the study has limitations. As only children on Alabama’s Medicaid, the publicly funded health care program for low-income Americans, were included, other populations may show different trends. The researchers also did not examine oral health behaviors such as teeth brushing or environmental ones like water fluoridation.

“It’s a bit surprising that we found so few benefits, especially since parents are routinely encouraged to take their children for early dental checkups,” Morrisey said. “Still, it is possible that even though the dentist visits were coded as preventive, the babies and toddlers already had some sign or risk factor of tooth decay. To really answer the question of efficacy of early routine checkups, one should do randomized clinical trials.”

It was also not clear from the data analyzed in the study what each preventive care visit involved. Typically, the main service at these visits is a topical fluoride varnish, but children who already have high levels of tooth decay may continue to get new decay even when the varnish is applied. These visits may also serve as an opportunity for parents to ask questions about how best to teach their children good oral care habits. “All I can recommend is that parents follow the advice of their child’s dentist or health care provider,” Morrisey said. “We examined the data in the aggregate, but only those seeing the individual child will be able to determine what’s best for him or her.”