Children who don't go to the dentist are less likely to participate in school-based cavity prevention programs, according to research published in JAMA Network Open.
"Our study suggests that children who may need these services the most are the ones least likely to receive them," said health economist and study author Shulamite Huang , an assistant professor of epidemiology and health promotion at NYU College of Dentistry.
In addition, the study found that improving participation in state-wide school dental programs to reach those at high risk for tooth decay could yield significant savings for state Medicaid programs and health care systems, averting up to $2.4 million in emergency department charges annually in New York.
Children miss more than 34 million hours of school each year to receive emergency dental care. In recent years, hospitals have seen a sharp increase in emergency room visits for pediatric dental issues.
To prevent tooth decay and the related pain and infections that land kids in the ER, some schools offer cavity prevention programs. New York State recently announced a $10 million initiative to expand access to school-based dental programs and improve children's oral health.
Research shows that school dental programs, which use non-invasive treatments like sealants, are effective at preventing cavities. But parents must opt in for their kids to receive care in school, and it's unclear if these programs reach those who are most in need.
Huang and her colleagues evaluated data from more than 63,000 children living in the Bronx and covered by Medicaid, including more than 1,000 children who participated in school-based cavity prevention programs in local elementary schools. They looked at Medicaid claims data to see whether children had visited a dentist outside of school or received emergency dental care.
The researchers found that kids who already had a history of dental care were more likely to participate in school-based cavity prevention programs. In contrast, children with no prior dental visits were 18 percent less likely to participate in these programs. Children with a history of dental emergencies (and probably at high risk for tooth decay) were also less likely to participate in school-based programs.
The researchers then calculated the potential cost savings of expanding school-based dental care across New York State and improving participation among the children most at risk for tooth decay. They estimate that optimizing recruitment to enroll high-need children in school programs could save the state up to $2.4 million annually in dental-related emergency department costs (not including dental care related to accidents or injuries).
"This has staggering implications for Medicaid costs," said Huang. "As New York expands access to school-based dental care, improving recruitment strategies and reorienting outreach to high risk-children could save the state millions and offset some of the costs of expanding care."
Additional study authors include Ryan Richard Ruff of the University of Pennsylvania School of Dental Medicine, Heather Gold of NYU Grossman School of Medicine, and Scarlett Wang of NYU Wagner School of Public Service. The research was supported by the National Institutes of Health (K25 DE028584-01A1 and K25 DE028584-02S1).
