Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 906-914 (doi:10.1542/peds.2004-1687)

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Estimated Impact of Competing Policy Recommendations for Age of First Dental Visit

Kari Jones, PhD^*, Scott L. Tomar, DMD, DrPH

^* Division of Public-Private Partnerships, National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, Georgia
Division of Public Health Services and Research, College of Dentistry, University of Florida, Gainesville, Florida

Objective. To compare levels of dental utilization and untreated dental decay among children aged 1 to 3 years that are likely to occur under 2 potential guidance policies: (1) pediatricians refer all toddlers to dentists for screening (consistent with American Academy of Pediatric Dentistry and the American Dental Association recommendations; DENT), and (2) pediatricians receive training in caries risk assessment, screen toddlers, and refer at-risk children to dentists (consistent with American Academy of Pediatrics recommendations; PED).

Methods. Using decision analysis, we estimated the impact of PED and DENT assuming alternately unlimited dental capacity for Medicaid-insured patients and fixed Medicaid dental capacity.

Results With unlimited capacity, if DENT were implemented, then dental utilization is estimated to increase from 27% under the status quo to 65% and untreated decay to decrease from a mean of 0.60 surfaces to 0.52 surfaces per child. If PED were implemented, then dental utilization and untreated decay would decrease from status quo levels to an estimated 11% and 0.47 surfaces, respectively, assuming that diagnostic sensitivity and specificity both equaled 1; they would decrease to 13% and 0.53 surfaces, respectively, if sensitivity equaled 0.76 and specificity equaled 0.95. With fixed capacity, under DENT, untreated decay is estimated to increase to 0.63 surfaces because low-risk private-pay patients would crowd out at-risk Medicaid-insured children, whereas under PED, untreated decay would still be less than under the status quo.

Conclusions. Implementing PED will decrease untreated decay under most plausible scenarios, whereas switching to DENT will increase the burden of disease if Medicaid dental capacity is limited.

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Key Words: delivery of dental care • dental health services • dental care for children • dentist's practice patterns • dental economics • health policy • pediatrics • dental caries

Abbreviations: AAP, American Academy of Pediatrics • SQ, status quo • SCHIP, State Children's Health Insurance Program • NHANES III, Third National Health and Nutrition Examination Survey • p_low, proportion of toddlers from families with incomes 200% of the federal poverty threshold • pSQdvisithigh, proportion of high-income toddlers with past-year dental visit • pSQdvisitlow, proportion of low-income toddlers with past-year dental visit • pDENTdvisithigh, proportion of high-income toddlers with past-year dental visit if AAP lowered recommended age for first dental visit to 1 year • pDENTdvisitlow, proportion of low-income toddlers with past-year dental visit if AAP lowered recommended age for first dental visit to 1 year • ppedvisithigh, proportion of high-income toddlers with past-year visit to pediatrician or primary care provider • ppedvisitlow, proportion of low-income toddlers with past-year visit to pediatrician or primary care provider • pdh, untreated decay prevalence (at least 1 tooth surface has untreated decay) among high-income toddlers • pdl, untreated decay prevalence among low-income toddlers • dh, untreated decay severity (mean number of decayed tooth surfaces) among high-income toddlers • dl, untreated decay severity among low-income toddlers • pch, caries prevalence (at least 1 filled or untreated decayed tooth surface) among high-income toddlers • pcl, caries prevalence among low-income toddlers • ch, caries severity (mean number of filled or untreated decayed tooth surfaces) among high-income toddlers • cl, caries severity among low-income toddlers • PFh, percentage reduction in untreated decay among high-income toddlers attributable to a past-year dental visit • PFl, percentage reduction in untreated decay among low-income toddlers attributable to a past-year dental visit

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Accepted Aug 5, 2004.

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