Preventive dental utilization for Medicaid‐enrolled children in Iowa identified with intellectual and/or developmental disability

Department of Pediatric Dentistry, The University of Iowa
Journal of Public Health Dentistry (Impact Factor: 1.21). 12/2009; 70(1):35 - 44. DOI: 10.1111/j.1752-7325.2009.00141.x

ABSTRACT Objectives: To compare preventive dental utilization for children with intellectual and/or developmental disability (IDD) and those without IDD and to identify factors associated with dental utilization.Methods: We analyzed Iowa Medicaid dental claims submitted during calendar year (CY) 2005 for a cohort of children ages 3-17 who were eligible for Medicaid for at least 11 months in CY 2005 (n = 107,605). A protocol for identifying IDD children was developed by a group of dentists and physicians with clinical experience in treating children with disabilities. Utilization rates were compared for the two groups. Crude and covariate-adjusted odds ratios were estimated using conditional logistic regression modeling.Results: A significantly higher proportion of non-IDD children received preventive care than those identified as IDD (48.6 percent versus 46.1 percent; P < 0.001). However, the final model revealed no statistically significant difference between the two groups. Factors such as older age, not residing in a dental Health Professional Shortage Area, interaction with the medical system, and family characteristics increased one's likelihood of receiving preventive dental care.Conclusion: Although IDD children face additional barriers to receiving dental care and may be at greater risk for dental disease, they utilize preventive dental services at the same rate as non-IDD children. Clinical and policy efforts should focus on ensuring that all Medicaid-enrolled children receive need-appropriate levels of preventive dental care.

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    ABSTRACT: Objectives. We evaluated the relationship between dentist supply and children's oral health and explored heterogeneity by children's age and urbanicity. Methods. We obtained data from the 2007 National Survey of Children's Health (> 27 000 children aged 1-10 years; > 23 000 children aged 11-17 years). We estimated the association between state-level dentist supply and multiple measures of children's oral health using regression analysis adjusting for several child, family, and population-level characteristics. Results. Dentist supply was significantly related to better oral health outcomes among children aged 1 to 10 years. The odds of decay and bleeding gums were lower by more than 50% (odds ratio [OR] = 0.46; 95% CI = 0.23, 0.95) and 80% (OR = 0.18; 95% CI = 0.05, 0.76), respectively, with an additional dentist per 1000 population. The odds of a worse maternal rating of child's dental health on a 5-category scale from poor to excellent were lower by about 50% in this age group with an additional dentist per 1000 population (OR = 0.51; 95% CI = 0.29, 0.91). We observed associations only for children in urban settings. Conclusions. Dentist supply is associated with improved oral health for younger children in urban settings. (Am J Public Health. Published online ahead of print August 14, 2014: e1-e7. doi:10.2105/AJPH.2014.302139).
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    ABSTRACT: Objectives. The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children. Methods. Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). Results. The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). Conclusions. Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children. (Am J Public Health. Published online ahead of print May 15, 2014: e1-e7. doi:10.2105/AJPH.2014.301927).
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    ABSTRACT: Abstract The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults age 18 years or older. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 0.91, 1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (OR = 0.49; 95% CI = 0.44, 0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions, whereas adults with IDDs are at significantly reduced odds.
    Intellectual and developmental disabilities. 06/2014; 52(3):193-204.

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