Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e805-e814 (doi:10.1542/peds.2008-0118)
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ARTICLE

Linking Mother and Child Access to Dental Care

David Grembowski, PhDa,b, Charles Spiekerman, PhDa and Peter Milgrom, DDSa,b

Departments of aDental Public Health Sciences
b Health Services, University of Washington, Seattle, Washington


   ABSTRACT
TOP
 ABSTRACT
METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
OBJECTIVES. Among young children in low-income families covered by Medicaid, we estimated (according to racial/ethnic group) whether children who have mothers with a regular source of dental care at baseline have greater dental use in the subsequent year than children with mothers without a regular source.

METHODS. From a population of 108151 children (aged 3 to 6 years) who were enrolled in Medicaid and their low-income mothers in Washington state, a disproportionate stratified random sample of 11305 children aged 3 to 6 was selected from enrollment records in 4 racial/ethnic groups: black (3791), Hispanic (2806), white (1902), and other racial/ethnic groups (2806). In a prospective cohort design, we conducted a baseline survey of mothers and for respondents collected their children's Medicaid dental claims in the 1-year follow-up period. Mutivariable regression models estimated the associations between the mothers' having a regular source of dental care at baseline and their children's prospective dental use.

RESULTS. Approximately 38% of the mothers had a regular source of dental care. Among children of black and Hispanic mothers, having a mother with a regular source of dental care at baseline was associated with greater odds of receiving any dental care in the subsequent year. For children with dental use, children of black or Hispanic mothers with a regular source of dental care received 1.22 and 1.10 more preventive services, respectively. For children of white mothers, associations were in the same direction but not significant.

CONCLUSIONS. For young children of black and Hispanic mothers, dental care use is higher when their mothers have a regular source of dental care. For low-income young children with Medicaid, increasing the mothers' access to dental care may increase the children's use of dental and preventive services, which, in turn, may reduce racial/ethnic inequalities in oral health.

Key Words: children • mothers • access to dental care • regular source of dental care • dental insurance • Medicaid

Abbreviations: RSDC—regular source of dental care • FPL—federal poverty level • ABCD—Access to Baby and Child Dentistry • SESRC—Social and Economic Science Research Center • OR—odds ratio • CI—confidence interval

Tooth decay is a growing, severe problem among low-income and minority preschool-aged children that is compounded by limited access to dental care.1–4 Simply increasing children's access to dental care through universal dental insurance may not reduce the inequalities in oral health.5

An alternative approach to solving this public health problem may exist through the links between mother and child access to dental care and oral health.6 If low-income mothers have a regular source of dental care (RSDC) and receive preventive services, then oral health benefits may accrue to both mother and child through biological and dental care pathways. Mothers are the primary source of the dental caries bacteria infection in their children, and delivery of caries-preventive technologies to mothers effectively reduces their cariogenic bacteria and the caries experiences of their infants.6–18 Through regular dental care, mothers build positive dental knowledge, attitudes, and self-care practices,19,20 which may influence whether she takes her child to the dentist.21 A dentist who has the mother as a patient may be more likely to accept her Medicaid-enrolled child.

Medical studies usually report that individuals with a regular place or provider of care have more physician visits and preventive services and less illness care than individuals without a regular place or provider22–28; however, few studies have examined whether an association exists between mothers' RSDC and their preschool-aged children's dental use. In a cross-sectional study of Seattle children aged 5 to 11 years, children of low-income mothers who had an RSDC had greater odds of a dental visit.21 A cross-sectional Detroit, Michigan, study reported that black caregivers with preventive dental visits were more likely to take their preschool-aged children to the dentist.29 No longitudinal study of low-income, young children has examined whether mothers' having an RSDC at baseline is related to their children's dental use in the future.

Because Medicaid eligibility differs for low-income mothers and children, no association may exist between mother RSDC and their preschool-aged children's prospective dental use. As a result of Medicaid and the State Children's Health Insurance Program, children up to 250% of the federal poverty level (FPL) have the highest rates of dental insurance coverage in the United States,30 partly because only approximately half of the US population has public or private dental insurance.31 In contrast, pregnant women qualify for Medicaid only when their family incomes are at <133% of the FPL or higher in some states, but at 60 days postpartum, eligibility reverts to the FPL.32 Because mothers without dental insurance are less likely to have an RSDC,33 the mother–child difference in Medicaid coverage may undermine the potential link between the mother's RSDC and child's dental use.

We addressed this question in a population-based sample of young children who were in low-income families in Washington state and had Medicaid dental insurance. Our purpose was to evaluate, according to racial/ethnic group, whether children who had mothers with an RSDC at baseline had greater dental use in the subsequent year than children of mothers without an RSDC.


   METHODS
TOP
 ABSTRACT
 METHODS
RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Population, Sample, and Study Design
The population consisted of 108151 children who were enrolled in Medicaid (the US public dental insurance program for low-income individuals) and aged 3 to 6 years and their mothers in Washington state (children's household income eligibility for Medicaid in Washington state is 250% of the FPL). We chose children aged 3 to 6 years because the primary dentition would be erupted fully, and dental use for children who were younger than 3 was <30%,34 which decreases the likelihood of detecting an association between mothers' RSDC and their children's dental use.

In April 2004, a disproportionate stratified random sample of 11305 preschool-aged children aged 3 to 6 was selected from Medicaid enrollment records in 4 racial/ethnic groups: black (3791), Hispanic (2806), white (1902), and other racial/ethnic groups (2806). When a household had >1 child in the age range, 1 child was selected randomly.

The prospective cohort study design consisted of a baseline survey of children's mothers in September to December 2004, followed by an analysis of the children's dental use from Medicaid dental claims from January to December 2005. Study protocols were approved by the Washington State institutional review board.

Measures
Measures were derived from the conceptual model of dental care by Grembowski et al.19

Mothers' RSDC
RSDC was measured by whether a mother had a regular place of dental care or regular dentist on the basis of Starfield's35 definition of a regular source of care: 1 place, 1 provider over time for preventive and therapeutic care. Measures that satisfied Starfield's criteria were constructed from usual source of health care items in previous medical and dental surveys.36–38

A mother had a regular place of dental care when she (1) responded "yes" to, "Is there a particular dental office, clinic, health center, or other place that you usually go to for dental care?" (2) the place where the mother goes was not a hospital emergency department; (3) she went to the place for ≥1 year; and (4) the place was a source of preventive services, measured by having teeth cleaned in the past 2 years.33 Mothers had a regular dentist when (1) items 1, 2, and 4 for a regular dental place were met, (2) mothers reported seeing the same dentist each time they went there, and (3) mothers went to that dentist for ≥1 year. When mothers had a regular place or dentist, we asked whether mother and child had the same place of dental care and dentist.

Mother, Family, and Place Characteristics
Mothers' race/ethnicity was measured by the question, "What race or ethnic background best describes you?" with responses of Hispanic, Latino, or Spanish; white, not Hispanic; black or African American; American Indian; Alaska Native; Asian (eg, Vietnamese, Korean, Japanese, Filipino, Chinese, Asian Indian); Pacific Islander (eg, Hawaiian, Samoan); or some other race/ethnicity. Socioeconomic status was measured by the mother's highest educational degree, employment status, and family income in 2003 (categorized by less than $10000, between $10000 and $20000, and more than $20000). Dental insurance was measured by whether the mother had no dental insurance, Medicaid, or private dental insurance from an employer. Mother characteristics included mother's age, single parent, current cigarette smoker, which mode of the survey the mother completed, and dental fear.39 Mental health symptoms in the past 4 weeks were assessed by the 5-item mental health scale with scores ranging from 1 (best) to 6 (worst). Categories 5 and 6 were combined because few mothers had severe symptoms. Average scores were rounded and recoded as 5 binary variables for each value, ranging from 1 (best) to 5 (worst).40,41 Mothers reported whether they were born in the United States.

Residence characteristics included years living at current address and county. We also measured whether place of residence was rural or urban on the basis of rural-urban commuting area codes.42 Dentist supply in the child's county was measured by the number of active licensed dentists per 10000 population in 200343 and the number of county dentists who submitted Medicaid claims per 10000 population in 2004 obtained from Medicaid records.

Child Dental Use and Expenditures
Children's dental use and expenditures were measured from Medicaid dental claims for January to December 2005. Applying the 2-part model to use, we measured whether a child had any Medicaid claims and, given any use, the number of services, defined by Medicaid dental procedure codes, in each of 6 categories of dental care: oral examination, diagnostic, preventive, restorative, surgical and adjunctive, and total expenditures on the basis of allowed Medicaid fees.44 We measured the percentage of the follow-up period the child was covered by Medicaid by using eligibility periods in the Medicaid eligibility file.

Child Characteristics
Child survey measures included gender; age; and mother's rating of the child's dental fear, oral health, and pain.37,39 The following child measures were collected from Medicaid records to compare children with and without completed questionnaires: whether child had any Medicaid dental claims in January to April 2004 before the sample was drawn; gender; age; number of family members; whether child was disabled; whether child was member of an American Indian tribe; whether child immigrated; whether English was family's primary language; and whether child enrolled in Access to Baby and Child Dentistry (ABCD), a program to increase access to dental care for preschool-aged children who are enrolled in Medicaid in Washington state.37,45

Data Collection
On June 11, 2004, the Department of Social and Health Services, which administers the Medicaid Program, mailed the parents of sampled children letters in English, Spanish, Vietnamese, and Russian, the most prevalent primary languages in the population on the basis of Medicaid records, describing the study and containing instructions to notify the Department of Social and Health Services if they did not want to participate. By the July 14 deadline, 396 parents opted out of the study or had nondeliverable letters, leaving 10909 participants.

The Social and Economic Science Research Center (SESRC) at Washington State University performed a mixed-mode, Web-mail-telephone survey of mothers by using methods developed by Dillman and colleagues.46 Medicaid eligibility files contained a child's name, address, telephone number, and primary language but did not indicate mother's name. Contact materials were addressed "To the Mother of [child's full name]," and all letters and instruments were at the sixth- to eight-grade reading level. English instruments were translated into Spanish, Russian, and Vietnamese by professional translators at the Academy of Languages (www.aolti.com). All modes of the instrument contained the same 66 questions with 109 items.

Starting September 3, SESRC mailed invitation letters to the 10909 mothers to complete the Web survey, with a Spanish letter also included for families with that primary language. Each letter contained a unique password for accessing the Web survey, and respondents were entered into a drawing for 25 $50 grocery certificates. The Web survey was closed on November 3.

Beginning September 27, mothers who had not completed a Web questionnaire were sent a mail questionnaire with letters in English and Spanish to everyone with a $2 bill incentive in the first mailing. Follow-ups to nonrespondents included a thank you/reminder postcard mailed 2 weeks later to everyone, and replacement questionnaires and cover letter were mailed to nonrespondents of the Web and mail questionnaire 4 weeks later by US priority mail. Questionnaires received by January 31, 2005, were included in the study.

Starting November 3, SESRC mailed letters to mothers who had not responded to the Web or mail questionnaires and invited them to complete a telephone interview in English, Spanish, Russian, or Vietnamese. When a contacted parent refused to participate, refusal conversions were not attempted, and calling ended on December 31, 2004. Completed instruments from the 3 modes were combined for the analysis.

After the 1-year follow-up in 2006, personal characteristics, enrollment information, and January 2004 to December 2005 dental claims with encrypted identifiers were collected from Medicaid for children with a completed survey and linked with survey data using a file from SESRC that contained each child's survey identifier and encrypted Medicaid identifier. Medicaid records without personal identifiers also were collected for children without completed questionnaires, excluding survey refusals, containing child characteristics and January to April 2004 Medicaid dental use.

Data Analysis
Bivariate tests compared the characteristics and dental use of children with and without completed questionnaires, excluding children whose mothers refused study participation. Pearson {chi}2 test and analysis of variance determined whether child and mother characteristics and the percentage of mothers with an RSDC were significantly different for black, Hispanic, and white participants. For mothers with an RSDC in each racial/ethnic group, we used Pearson {chi}2 test and analysis of variance to test whether a mother and a child with the same place or dentist had greater child dental use than a mother and a child with different places or dentists.

We use generalized linear models with a logit link to estimate whether mothers' RSDC (measure of a regular place or dentist) at baseline was associated with the probability of any child use of dental care in the follow-up year. Among children with any dental use, we used Poisson and {gamma} link functions for number of services and expenditures among child users, respectively.44,47 RSDC effects may differ for any use versus intensity of care among users, mainly because the mother rather than the dentist usually makes the initial decision to seek dental care for the child, whereas dentists largely make treatment decisions for children with visits.

Separate models were estimated for black, Hispanic, and white mothers. Models were estimated in 3 steps, initially entering child covariates, adding mother and family covariates, and finally entering propensity scores to attempt to correct for potential endogeneity between RSDC and child dental use.22–25 An RSDC is not a randomly assigned attribute. Mothers who have an RSDC may differ from those who do not in observed and unobserved ways, and the differences in the mothers may also contribute to differences in their children's dental use. We estimated the propensity of mothers' having an RSDC as a function of age, race/ethnicity, income, education, employment status, dental insurance, survey mode, years in current residence and county, rural or urban residence, and county dentist/population ratio. The propensity score was then categorized into quintiles and added to the final model.44 Regression analyses were performed for children with complete data across all 3 models. For mothers with an RSDC, analyses were repeated in each racial/ethnic group to test whether child dental use or expenditures differed for mothers with a regular dentist and mothers with only a regular place. Models were estimated by using R 2.2.1 statistical software (R Foundation for Statistical Computing, Vienna, Austria).

Analyses were repeated for 2 racial/ethnic groups, American Indian and Asian mothers, in the fourth racial/ethnic group of the study's disproportionate stratified sample. Because sample sizes are small, these analyses are exploratory.


   RESULTS
TOP
 ABSTRACT
 METHODS
 RESULTS
DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Survey and Eligibility
In total, 4762 parents completed the Web (n = 306), mail (n = 3329), or telephone (n = 1127) instruments. The unadjusted response rate is 44% (4762 of 10909), and, excluding the 4387 households with ineligible individuals or inaccurate contact information, the contact rate was 73% (4762 of 6522).33

Compared with children without questionnaires (n = 5444), children with completed questionnaires had similar characteristics but were more likely to have a Medicaid dental claim in January to April 2004 (43% vs 36%; P < .001) and be enrolled in ABCD (18% vs 13%; P < .001) and less likely to be from an American Indian tribe (3.6% vs 5.1%; P < .001).

After exclusion of respondents who were not mothers, 4364 mothers remained. From those, we excluded 256 children who were not enrolled in Medicaid at least 30 days in the follow-up period. Of the remaining 4108, we excluded 550 children with private dental insurance because their dental use could not be measured accurately by Medicaid dental records. We excluded from analyses 115 mothers who declined to specify their race, 155 who specified "other" race, and 70 who specified >1 race/ethnicity. Analyses were based on the remaining 3218 mothers in the following racial/ethnic groups: black (n = 675), Hispanic (n = 1156), white (n = 1094), Asian (n = 183), and American Indian (n = 110).

Characteristics of Mothers and Children According to Racial/Ethnic Group
Table 1 compares the personal characteristics of mothers and children according to racial/ethnic group. Statistically significant differences exist for almost all of the characteristics across the black, Hispanic, and white racial/ethnic groups.


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  		TABLE 1 Personal Characteristics of Mothers and Children According to Racial/Ethnic Group

 
Mothers' RSDC
The percentage of mothers with a regular place of dental care was similar across racial/ethnic groups (black: 36%; Hispanic: 39%; white: 37% [P = .37]). Of these, ~40% of the black and white mothers and 59% of the Hispanic mothers reported that mother and child had the same place of dental care (P < .001). Approximately 36% of the Asian mothers and 43% of the American Indian mothers had a regular source.

The percentage of mothers with a regular dentist differed according to racial/ethnic group (black: 22%; Hispanic: 24%; white: 31% [P < .001]). Most of these mothers and children saw the same dentist (black: 84%; Hispanic, 75%; white: 92% [P < .001]). Approximately 25% of the Asian mothers and 28% of the American Indian mothers had a regular dentist.

Mothers' RSDC and Children's Dental Use
Table 2 presents descriptive statistics for children's dental use and expenditures in the 1-year follow-up period. Hispanic children were more likely to have any dental use (78%) than black (62%) or white (67%) children (P < .001). Among children with any dental use, children of Hispanic mothers had the highest average dental expenditures and received more services in each of the 6 categories and for most specific dental services. In contrast, children of black mothers had the lowest average dental expenditures and services. Approximately 67% of children of Asian mothers and 52% of children of American Indian mothers had any dental use. Among children with dental use, average (SD) 2005 expenditures were $256 ($278) and $324 ($444) for children of Asian and American Indian mothers, respectively.


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  		TABLE 2 Annual (2005) Dental Use and Expenditures From Medicaid Dental Claims for Young Medicaid-Insured Children According to the Mother's Racial/Ethnic Group

 
Figure 1 indicates the percentage of children with dental care use in the 1-year follow-up period for mothers with an RSDC versus without an RSDC. The differences in use were smallest for white mothers (66% vs 70%; P = .22) and were larger for Hispanic mothers (75% vs 83%; P < .01) and black mothers (58% vs 69%; P < .01). The percentage of children with any dental use was similar for children of Asian mothers who had an RSDC (69%) versus no RSDC (66%; P = .67) and for children of American Indian mothers who had an RSDC (50%) versus no RSDC (53%; P = .74). The likelihood of child dental use was not significantly different for mothers and children with the same place of dental care or dentist versus mothers and children with different places or dentists.


Figure 1
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  		FIGURE 1 Percentage of children with dental care use in the 1-year follow-up period when their mothers had an RSDC versus those who did not have an RSDC at baseline, according to the mothers' racial/ethnic group (Washington State, 2005).

 
Tables 3 and 4 present odds ratios (ORs) indicating whether mothers who had an RSDC at baseline was associated with their children's dental use in the 1-year period after the survey, after adjustment for possible confounders in 3 models that contained children's covariates, children's and mothers' covariates, and the mothers' propensity to have an RSDC, respectively. In each racial/ethnic group, estimates were similar across models. In the Hispanic and black regression models, children whose mothers had an RSDC at baseline had greater odds (1.69–1.84) of receiving any dental care in the subsequent year, depending on the independent variables in the model (P = .024–0.003). In final models, the ORs were 1.69 (P = .017) for children of black mothers and 1.84 for children of Hispanic mothers (P = .003). For white mothers, the OR (1.12) was in the expected direction but smaller and not significant. Final models estimated excluding children in ABCD had similar results (OR: 1.73 [P = .01] for children of black mothers; OR 1.59 [P = .04] for children of Hispanic mothers; OR 1.10 [P = .65] for children of white mothers).


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  		TABLE 3 Estimated Effects of Mothers' RSDC at Baseline (2004) on Whether Children Received Any Medicaid Dental Care in the Subsequent Year (2005), According to the Mothers' Racial/Ethnic Group

 

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  		TABLE 4 Among Children Receiving Medicaid Dental Care in 2005, Estimated Effects of Mothers' RSDC at Baseline (2004) on Children's Medicaid Dental Expenditures and Number of Services in the Subsequent Year (2005), According to the Mothers' Racial/Ethnic Group

 
Overall, for children who had dental care use, having a mother with an RSDC was not related to children's dental expenditures and number of examination, diagnostic, restorative, surgical, or adjunctive services; however, children of black or Hispanic mothers who had an RSDC received 1.22 and 1.10 more preventive services, respectively, compared with children of mothers without an RSDC (P = .002 for black children and P = .03 for Hispanic children). Similar results were obtained in regression models with all children regardless of dental use (relative ratio: black children: 1.42 [95% confidence interval (CI): 1.26–1.60]; Hispanic children: 1.22 [95% CI: 1.12–1.32]).

For mothers with a regular place of dental care, child dental use and expenditures generally were not significantly different when their mothers had a regular dentist versus when their mothers had only a regular place; however, for children with dental care use, children of black or white mothers who had a regular dentist received more preventive services in final regression models (adjusted black rate difference: 17% [95% CI: 2%–34%]; white rate difference: 9% [95% CI: 0%–20%]; Hispanic rate difference: 5% [95% CI: –4% to 16%]).


   DISCUSSION
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
CONCLUSIONS
 REFERENCES
 
For young children of low-income families covered by Medicaid, we found that having a mother with an RSDC at baseline was associated with greater odds of the child's receiving dental care in the subsequent year, controlling for child and mother characteristics and the mother's propensity to have an RSDC. Mothers' RSDC also was associated with children's receiving more preventive services. These relationships were found for children with black and Hispanic mothers; for children with white mothers, the relationships were in the same direction but smaller in size and not statistically significant. The findings are consistent with medical studies indicating that parental, particularly maternal, health care use is associated with children's use.48–51

The findings are noteworthy given that black and Hispanic children are less likely than white children to receive preventive dental care.34,52 For mothers with an RSDC, child dental use and expenditures generally were not significantly different when their mothers had a regular dentist versus only a regular place in each racial/ethnic group.

A regular source may have a stronger association with child dental use for children with black and Hispanic mothers than white mothers because of the minority mothers' experiences in overcoming barriers to dental care. Several US studies documented that racial/ethnic minority families with low incomes confront more barriers to dental care, have lower access, and receive fewer preventive services than other groups.1,19,53 Black and Hispanic mothers who successfully developed an RSDC may have gained knowledge and skills in navigating the dental care system and negotiating the barriers, which may have helped them to overcome discriminatory treatment, difficulty in locating dentists who accept Medicaid, and other barriers to dental care for their children.54–56

An RSDC for mothers may also be related to child dental care use because a regular source shapes mothers' dental knowledge, values and attitudes, and oral health behaviors, which, in turn, may play an important role in shaping the dental practices of their children and increasing their children's access to dental care.20,57 This pathway may be true particularly for Hispanic mothers, who have less formal education than black and white mothers, and for black mothers, who are less likely to have preventive dental beliefs.

The relationship between mothers' RSDC and children's dental care use may exist because mothers and children receive care in the same place or see the same dentist; however, this argument is not supported, because for mothers with a regular place, only 40% to 59% reported that their children went to the same place for dental care.

Children with baseline questionnaires had similar characteristics as children without baseline questionnaires but were more likely to have a Medicaid dental claim in January to April 2004 before the baseline survey was conducted (43% vs 36%; P < .001), which suggests the 62% to 78% use rates for the 3 racial/ethnic groups are higher than the group rates in the Medicaid population. Lewis et al34 reported that in a national sample, 51% to 78% of children aged 3 to 5 had a preventive dental visit in the previous year, and other studies revealed similar trends.29,52

The percentage of children with dental use (62%–78%) was roughly double the percentage of mothers with an RSDC (~38%). One way to reduce the gap is to expand adult access to Medicaid and private dental insurance. Whereas Medicaid legally requires states to cover children, typically up to 200% of the FPL, adult coverage is optional, and, in 45 states, adults must have incomes below the FPL to qualify for Medicaid (the median state covers working parents up to 63% of the FPL; 41% for nonworking parents).58,59 Even when mothers are eligible for Medicaid, 4 states do not cover adult dental services and 15 states cover only emergency care. Although most states cover pregnant women with incomes up to 185% of the FPL or higher, coverage does not extend into children's preschool years, when mother–child transmission of bacteria occurs. In 2006, Massachusetts expanded Medicaid dental insurance to cover low-income women with children younger than 3, which may increase the percentage of mothers with an RSDC.60

Mothers with Medicaid dental coverage also face access barriers because dentist participation in Medicaid is low as a result of low fees and other reasons. Increasing Medicaid dental fees, as well as increasing the number of dentists and public dental clinics, may increase the number of mothers with an RSDC.33,61–63

Policy makers are searching for "leveling-up" strategies that effectively reduce health inequalities across social groups.1,64,65 Our findings suggest that population-based interventions to increase the percentage of low-income mothers with an RSDC may have greater benefits for the children of black and Hispanic mothers than children of white mothers, potentially reducing inequalities in young children's access to dental care and preventive services, which, in turn, may reduce racial/ethnic inequalities in oral health. A community-based Medicaid intervention in Oregon successfully increased the percentage of pregnant women with a dental home.66 On the basis of the percentages in Fig 1 and Table 3 ORs, if black mothers without an RSDC later establish an RSDC, then our results suggest that the annual dental use of their preschool-aged children would increase, on average, from 58% to 70%. For Hispanic mothers, the increase would be from 75% to 84%.

Our findings are limited to low-income mothers of children who were aged 3 to 6 and were enrolled in Medicaid dental insurance in Washington state and to those sampled mothers who responded to our survey. Findings may not be generalizable to other places. Because low-income mothers are not randomly assigned to an RSDC, associations between mothers' RSDC and children's dental use may not be causal.


   CONCLUSIONS
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
REFERENCES
 
In our sample, dental use was higher for children with black or Hispanic mothers when their mothers had an RSDC. Our findings suggest that increasing the percentage of mothers with an RSDC may increase their children's dental use and preventive services, which, in turn, may reduce decay.67 If interventions increase equally the percentage of mothers with an RSDC across racial/ethnic groups, then our results suggest that black and Hispanic children may benefit most, which may ultimately reduce racial/ethnic inequalities in young children's tooth decay.


   ACKNOWLEDGMENTS
 
This research was supported by grant DE14400 from the National Institute of Dental and Craniofacial Research, National Institutes of Health.

We acknowledge the substantial contributions of Dretha Phillips, survey principal investigator, along with John Tarnai, Bruce Austin, and staff from the Social and Economic Sciences Research Center at Washington State University, which performed the survey. We acknowledge and greatly appreciate the support received from Cathie Ott, Gary Coats, Margaret Wilson, and other personnel in the Health and Recovery Services Administration, where the Medicaid Program is administered in the Department of Social and Health Services in Olympia, Washington. We also thank Ginny English and William Laaninen at WithinReach for administrative assistance in processing the responses of parents who opted out of the study. We also thank William Trejo for computational support in creating the Medicaid use variables and Alice Gronski for assistance in manuscript preparation.


   FOOTNOTES
 
Accepted Jun 26, 2008.

Address correspondence to David Grembowski, PhD, University of Washington, Department of Dental Public Health Sciences, Box 357475, 1959 NE Pacific Street, Seattle, WA 98195-7475. E-mail: grem{at}u.washington.edu

The authors have indicated they have no financial relationships relevant to this article to disclose.

Interpretations of the results are the authors' own and do not necessarily represent the official opinion of the National Institute for Dental and Craniofacial Research, Social and Economic Sciences Research Center, Health and Recovery Services Administration, or WithinReach.


What's Known on This Subject

Few studies have examined whether an association exists between low-income mothers who have an RSDC and their preschool-aged children's dental use.

 

What This Study Adds

Young children of black and Hispanic mothers with an RSDC at baseline had greater dental use and received more preventive services in the subsequent year than children of mothers without an RSDC.

 


   REFERENCES
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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