R.G. Rozier

Effect of Early Preventive Dental Visits on Subsequent Dental Treatment and Expenditures

Objective:Professional organizations recommend a preventive dental visit by 1 year of age. This study compared dental treatment and expenditures for Medicaid children who have a preventive visit before the age of 18 months with those who have a visit at age 18–42 months. Methods:This retrospective cohort study used reimbursement claims for 19,888 children enrolled in North Carolina Medicaid (1999–2006). We compared the number of dental treatment procedures at age 43–72 months for children who had a visit by age 18 months with children who had a visit at ages 18–24, 25–30, 31–36, and 37–42 months using a zero-inflated negative binomial model. The likelihood and amount of expenditures at age 43–72 months were compared by group using a logit and ordinary least squares regression. Results:Children who had a primary or secondary preventive visit by age 18 months had no difference in subsequent dental outcomes compared with children in older age categories. Among children with existing disease, those who had a tertiary preventive visit by age 18 months had lower rates of subsequent treatment [18–24 mo incidence density ratio (IDR): 1.19, 95% confidence interval (CI), 1.03–1.38; 25–30 mo IDR: 1.21, 95% CI, 1.06–1.39; 37–42 mo IDR: 1.39, 95% CI, 1.22–1.59] and lower treatment expenditures compared with children in older age categories. Conclusions:In this sample of preventive dental users in Medicaid, we found that children at highest risk of dental disease benefited from a visit before the age of 18 months, but most children could delay their first visit until the age of 3 years without an effect on subsequent dental outcomes.

Effectiveness of a School-based Fluoride Mouthrinse Program

The aims of this study were to estimate the caries-preventive effects of a school-based weekly fluoride mouthrinse (FMR) program and to determine whether its effectiveness varied by school-level caries risk. We used clinical and parent-reported data for 1,363 children in grades 1 through 5 from a probability sample of North Carolina (NC) schoolchildren. Children’s caries experience was measured using decayed and filled primary (d2,3fs) and total (d2,3fs+D2,3MFS) tooth surfaces. Program participation was quantified using ‘FMR years’. To estimate caries risk at program entry, children were matched with NC kindergarten-surveillance data representing school-level mean untreated decay (low-risk school: < 1 and high-risk school: ≥ 1 untreated carious teeth). Mean d2,3fs was 4.1 [95% confidence limits (CL) = 3.7, 4.5]. Overall, each ‘FMR year’ was associated with weak reduction of caries prevalence in the primary [prevalence ratio (PR) = 0.98; 95% CL = 0.90, 1.06] and the mixed dentition (PR = 0.98; 95% CL = 0.91, 1.05). We found a trend toward a larger caries-preventive benefit among children in high-risk schools compared with those in low-risk schools (i.e., 55% vs. 10% caries reduction for 5 to 6 yrs of FMR participation compared to none). Although this difference was not confirmed statistically, our results indicate that children in high-risk schools, as identified by school-level surveillance data, may experience substantial caries-preventive benefits from long-term FMR participation.

Preventive Services by Medical and Dental Providers and Treatment Outcomes

Objective: Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment. Methods: We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding. Results: We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment =

Exploring the genomic basis of early childhood caries: a pilot study

172) and higher among children with only dentist visits (CRT = 1.48, payment =

Impact of Medicaid Policy on the Oral Health of Publicly Insured Children

234) and both PCP and dentist visits (CRT = 1.52, payment =

A Contemporary Examination of First and Second Permanent Molar Emergence

273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr. Conclusions: Because of children’s increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs.

Early Head Start, Pediatric Dental Use, and Oral Health–Related Quality of Life:

Objective A genetic component in early childhood caries (ECC) is theorized, but no genome‐wide investigations of ECC have been conducted. This pilot study is part of a long‐term research program aimed to: (1) determine the proportion of ECC variance attributable to the human genome and (2) identify ECC‐associated genetic loci. Methods The studys community‐based sample comprised 212 children (mean age=39 months; range = 30–52 months; males = 55%; Hispanic/Latino = 35%, African‐American = 32%; American Academy of Pediatric Dentistry definition of ECC prevalence = 38%). Approximately 2.4 million single nucleotide polymorphisms (SNPs) were genotyped using DNA purified from saliva. A P < 5 × 10−8 criterion was used for genome‐wide significance. SNPs with P < 5 × 10−5 were followed‐up in three independent cohorts of 921 preschool‐age children with similar ECC prevalence. Results SNPs with minor allele frequency ≥5% explained 52% (standard error = 54%) of ECC variance (one‐sided P = 0.03). Unsurprisingly, given the pilots small sample size, no genome‐wide significant associations were found. An intergenic locus on 4q32 (rs4690994) displayed the strongest association with ECC [P = 2.3 × 10−6; odds ratio (OR) = 3.5; 95% confidence interval (CI) = 2.1–5.9]. Thirteen loci with suggestive associations were followed‐up – none showed evidence of association in the replication samples. Conclusion This studys findings support a heritable component of ECC and demonstrate the feasibility of conducting genomics studies among preschool‐age children.

Determinants of Requests for Water Fluoride Assay Among North Carolina Dentists

Objective Fluoride varnish (FV) applications among non-dentist primary care providers has increased due to state Medicaid policies. In this study we examine the impact of FV policies on the oral health of publicly insured children aged 2–6xa0years old. Methods Using three waves of the National Survey of Children’s Health (2003, 2007, 2011/12), we used a logistic regression model with state and year fixed effects, adjusting for relevant child characteristics, to examine the association between years since a state implemented a FV policy and the odds of a publicly insured child having very good or excellent teeth. We compared children with public insurance in states with FV policies to children with public insurance in states without FV policies, controlling for the same difference among children with private insurance who were unlikely to be affected by Medicaid FV policies. Results Among 68,890 children aged 2–6 years, 38% had public insurance. Compared to privately insured children, publicly insured children had significantly lower odds of having very good or excellent teeth [odds ratio (OR) 0.70, 95% CI 0.62–0.81]. Publicly insured children in states with FV policies implemented for four or more years had significantly greater odds of having very good or excellent teeth (OR 1.28, 95% CI 1.03–1.60) compared to publicly insured children in states without FV policies. Conclusions for Practice State policies supporting non-dental primary care providers application of FV were associated with improvements in oral health for young children with public insurance.

Approximal caries and sugar consumption in Icelandic teenagers

The emergence of first permanent molars (FPMs) and second permanent molars (SPMs) is an important developmental milestone influencing caries risk and the timing of sealant placement. Emergence times have been shown to vary by sex and race/ethnicity, while recent reports suggest a positive association with adiposity. Amid the changing demographics of the US population and the rising rates of pediatric overweight/obesity, we sought to examine the association of body mass index (BMI) with FPM/SPM emergence in a representative sample of US children and adolescents. We used cross-sectional data from 3 consecutive cycles of the National Health and Nutrition Examination Survey (2009 to 2014). The FPM analysis included ages 4 to 8 y (n = 3,102 representing ~20 million children), and the SPM analysis included ages 9 to 13 y (n = 2,774 representing ~19 million children/adolescents). The Centers for Disease Control and Prevention’s growth chart data were used to calculate age- and sex-specific BMI percentiles, as measures of adiposity. Initial data analyses relied on descriptive statistics and stratified analyses. We used multivariate methods, including survey linear and ordinal logistic regression and marginal effects estimation to quantify the association between pediatric overweight/obesity and FPM/SPM emergence, adjusting for age, sex, and race/ethnicity. Forty-eight percent of 6-y-olds and 98% of 8-y-olds had all FPMs emerged, whereas SPM emergence varied more. Blacks (vs. whites) and females (vs. males) experienced earlier emergence of FPMs and SPMs. Overweight/obesity was associated with earlier FPM emergence, particularly among black females. Obesity but not overweight was associated with earlier SPM emergence. Overall, overweight/obesity accounted for 6 to 12 mo of dental acceleration. This study’s results emanate from the most recent US-representative data and affirm that FPM/SPM emergence varies by race/ethnicity and sex and is positively influenced by BMI. Future research should further elucidate these associations with detailed eruption data and examine the implications of this variation for clinical care.

Use of systemic fluoride supplements by North Carolina dentists

The objective of the study was to examine the mediating effect of child dental use on the effectiveness of North Carolina Early Head Start (EHS) in improving oral health–related quality of life (OHRQoL). In total, 479 parents of children enrolled in EHS and 699 parents of Medicaid-matched children were interviewed at baseline when children were approximately 10 mo old and 24 mo later. In this quasi-experimental study, mediation analysis was performed using the counterfactual framework analysis, which employed 2 logit models with random effects: 1) for the mediator as a function of the treatment and covariates and 2) for the outcome as a function of the treatment, mediator, and covariates. The covariates were baseline dental OHRQoL, dental need, survey language, and a propensity score. We used in-person computer-assisted, structured interviews to collect information on demographic characteristics and dental use and to administer the Early Childhood Oral Health Impact Scale, a measure of OHRQoL. Dental use had a mediation effect in the undesired direction with a 2–percentage point increase in the probability of any negative impact to OHRQoL (95% confidence interval [CI], 0.3%–3.9%). Even with higher dental use by EHS participants, the probability of any negative impact to OHRQoL was approximately 8 percentage points lower if an individual were moved from the non-EHS group to the EHS group (95% CI, −13.9% to −1.2%). EHS increases child dental use, which worsens family OHRQoL. However, EHS is associated with improved OHRQoL overall. Knowledge Transfer Statement: Study results can inform policy makers that comprehensive early childhood education programs improve oral health–related quality of life (OHRQoL) for disadvantaged families with young children in pathways outside of clinical dental care. This awareness and its promotion can lead to greater resource investments in early childhood education programs. Information about the negative impacts of dental use on OHRQoL should lead to the development and testing of strategies in dentistry and Early Head Start to improve dental care experiences.