How A North Carolina Program Boosted Preventive Oral Health Services For Low-Income Children

Dental caries, the most common chronic disease affecting young children, is exacerbated by limited access to preventive dental services for low-income children. To address this problem, North Carolina implemented a program to reimburse physicians for up to six preventive oral health visits for Medicaid-enrolled children younger than 36 months. Analysis of physician and dentist Medicaid claims from 2000 to 2006 shows the program substantially increased preventive oral health services. By 2006 approximately 30% of well-child visits for 6- to 36-month old children included these services. Additional strategies are needed to ensure preventive oral health care for more low-income children

Cost-effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees

Dental caries is the most common preventable chronic disease among preschool children. The pediatric primary care setting provides an alternative site to deliver preventive oral health. This study estimates the cost-effectiveness of a medical office-based preventive oral health program in North Carolina (“Into the Mouths of Babes,” IMB)

Effectiveness of Preventive Dental Treatments by Physicians for Young Medicaid Enrollees

To estimate the effectiveness of a medical office–based preventive dental program (Into the Mouths of Babes [IMB]), which included fluoride varnish application, in reducing treatments related to dental caries

Cost-effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees

OBJECTIVE: Dental caries is the most common preventable chronic disease among preschool children. The pediatric primary care setting provides an alternative site to deliver preventive oral health. This study estimates the cost-effectiveness of a medical office-based preventive oral health program in North Carolina (“Into the Mouths of Babes,” IMB). DESIGN: Observational study using Medicaid claims (2000–2006). SETTING: Medical staff delivered IMB services in medical offices. Dentists provided dental services in offices or hospitals. PARTICIPANTS: 209,285 Medicaid enrolled children at age 6 months. INTERVENTION: IMB visits included screening, parental counseling, topical fluoride application, and referral to dentists if needed. The cost-effectiveness analysis used the Medicaid program perspective and a propensity-score matched sample with regression analysis to compare children with ≥4 versus 0 IMB visits. MAIN OUTCOME MEASURES: Dental treatments and Medicaid payments for children up to age 6 enabled assessment of the likelihood that IMB was cost-saving and, if not, the additional payments per hospital episode avoided. RESULTS: IMB is 32% likely to be cost-saving with discounting of benefits and payments. On average, IMB visits cost $11 more than reduced dental treatment payments per person. The program almost breaks even if future benefits from prevention are not discounted and would be cost-saving with certainty if IMB services could be provided at$34 instead of $55 per visit. The program is cost-effective with 95$2331 per hospital episode avoided. CONCLUSIONS: IMB improves dental health for additional payments that can be weighed against unmeasured hospitalization costs