Impact of poor oral health on children's school attendance and performance.

OBJECTIVES: We examined school days missed for routine dental care versus dental pain or infection to determine the relationship between children's oral health status and school attendance and performance. METHODS: We used 2008 data from the North Carolina Child Health Assessment and Monitoring Program. The study sample, weighted to reflect the state's population, included 2183 schoolchildren. Variables assessed included school absences and performance, oral health status, parental education, health insurance coverage, race, and gender. RESULTS: Children with poor oral health status were nearly 3 times more likely (odds ratio = 3.89; 95% confidence interval = 1.96, 7.75) than were their counterparts to miss school as a result of dental pain. Absences caused by pain were associated with poorer school performance (P < .05), but absences for routine care were not. Mediation analyses revealed that oral health status was associated with performance independent of absence for pain. CONCLUSIONS: Children with poorer oral health status were more likely to experience dental pain, miss school, and perform poorly in school. These findings suggest that improving children's oral health status may be a vehicle to enhancing their educational experience.

Evaluation of knowledge, attitudes, and self-reported behaviors among 3-5 year old school children using an oral health and nutrition intervention.

METHODS: Ninety 3-5 year old children, 43 in the control group and 47 in the intervention group, participated in the study. An age and developmental appropriate prop-based oral health and nutrition intervention program was used. Subjects in the intervention group received a pre-test, an 8-10 minute prop-supported intervention, followed by an immediate post-test. The same test was repeated two weeks later The control group received a pre-test and post-test two weeks later but no intervention. RESULTS: Intervention improved scores in the immediate post-test but these improvements were not sustained two weeks later The only positive relationship found for the entire group between pre-and two week post-test scores was for oral health knowledge. There were no significant findings when adjusted for race, intervention type or group. CONCLUSIONS: Changing oral health and nutrition knowledge, attitude and behavior may require intense and repetitive interventions to have a significant effect in this age cohort.

The effects of the Women, Infants, and Children's Supplemental Food Program on dentally related Medicaid expenditures.

OBJECTIVE: This study estimates the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dentally related Medicaid expenditures for young children. METHODS: We used a five-year cohort study design to compare dentally related Medicaid expenditures for children enrolled in WIC versus those not enrolled for each year of life up to age 5 years. There were 49,795 children born in North Carolina in 1992 who met the inclusion criteria for the study. Their birth records were linked to Medicaid enrollment and claims files, WIC master files, and the Area Resource File. Our analysis strategy included a logit and OLS two-part model with CPI dollar adjustments. RESULTS: Children who participated in WIC at ages 1 and 2 years had significantly less dentally related expenditures than those who did not participate. WIC participation at age 3 years did not have a significant effect. Fewer WIC children received dental care under general anesthesia than non-WIC children. CONCLUSIONS: The WIC program has the potential for decreasing dentally related costs to the Medicaid program, while increasing use of dental services.

Early preventive dental visits: effects on subsequent utilization and costs.

OBJECTIVE: To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children. DESIGN: This investigation studied North Carolina children who were enrolled continuously in Medicaid from birth for a 5-year period. Our research design was a longitudinal cohort study that relied on 4 large administrative datasets, including North Carolina composite birth records from 1992, Medicaid enrollment and claims files from 1992 to 1997, and the Area Resource File. Our outcome measures included type of use and dentally related costs. RESULTS: Of the 53591 Medicaid-enrolled children born in 1992, 9204 were continuously enrolled for 5 years and met our inclusion criteria. Twenty-three children had their first preventive dental visit before 1 year of age, 249 between 1 and 2 years, 465 between 2 and 3 years, 915 between 3 and 4 years, and 823 between 4 and 5 years. Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. Those who had their first preventive visit at age 2 or 3 were more likely to have subsequent preventive, restorative, and emergency visits. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1, 262 dollars; age 1 to 2, 339 dollars; age 2 to 3, 449 dollars; age 3 to 4, 492 dollars; age 4 to 5, 546 dollars. CONCLUSIONS: Our results should be interpreted cautiously, because of the potential for selection bias; however, we concluded that preschool-aged, Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs. In addition, children from racial minority groups had significantly more difficulty in finding access to dental care, as did those in counties with fewer dentists per population.

Effects of WIC participation on children's use of oral health services.

OBJECTIVES: We estimated the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dental services use by Medicaid children in North Carolina. METHODS: We used linked Medicaid claims and enrollment files, WIC files, and the area resource file to compare dental services use for children enrolled in WIC with those not enrolled. We used multivariate models that controlled for child clustering and employed 2-step methodology to control for selection bias. RESULTS: Children who participated in WIC had an increased probability of having a dental visit, were more likely to use preventive and restorative services, and were less likely to use emergency services. CONCLUSIONS: Children's WIC participation improved access to dental care services that should lead to improved oral health.

Differences in use of health services between White and African American children enrolled in Medicaid in North Carolina.

OBJECTIVES: Racial differences in health status and use of health services persist in the United States and are not completely explained by differences in socioeconomic status. This study examines differences in use of health services between White and African American children enrolled in Medicaid, controlling for other factors that affect service use. We make comparisons for use of primary preventive services, diagnosis and treatment of selected common childhood illnesses, and Medicaid expenditures. METHODS: We linked Medicaid enrollment records, Medicaid paid claims data, and data on use of child WIC services to birth certificates for North Carolina children born in 1992 to measure use of health services and Medicaid expenditures by race for children ages 1, 2, 3, and 4. Logistic and Tobit regression models were used to estimate the independent effect of race, controlling for other variables such as low birth weight, WIC participation, and mother's age, education, and marital status. Since all children enrolled in Medicaid are in families of relatively low income, racial differences in socioeconomic status are partially controlled. RESULTS: African American children had consistently lower Medicaid expenditures and lower use of health services than did White children, after statistically controlling for other maternal and infant characteristics that affect health service use, including child WIC participation. For example, total annual Medicaid expenditures were 207-303 dollars less for African American children than for White children, controlling for other variables. African America children were significantly less likely to receive well-child and dental services than were White children. CONCLUSIONS: African American children enrolled in Medicaid use health services much less than White children, even when controlling for socioeconomic status and other factors that affect service use. Linking state administrative databases can be a cost-effective way of addressing important issues such as racial disparities in health service use.