Preventive dental care utilization and dental caries experience for Medicaid-enrolled adolescents in Oregon

Abstract

Background: Low-income adolescents experience inequities related to oral health and access to dental care. However, there are few studies on the influence of preventive dental care utilization on dental disease outcomes in low-income adolescents, and it is unclear whether having a chronic condition (CC) could moderate the effects of preventive care. Objective: This study aimed to evaluate the relationship between preventive dental care utilization and dental caries experience for Medicaid-enrolled adolescents and to determine if the relationship is moderated by CC status. Methods: This was a secondary, cross-sectional analysis of Medicaid claims and survey data for 335 Oregon adolescents (ages 12 to 18 years) who received a dental screening between December 2015 and December 2016. We focused on a subset of adolescents who were enrolled in Oregon Medicaid for at least 11 months in 2015 and/or 2016 (n=240). The outcome was dental caries experience, defined as total decayed, missing, or filled tooth (DMF surfaces). The independent variable was preventive dental care utilization 12 months before the screening exam, which was identified using CDT codes. Chronic conditions were defined using inpatient and outpatient medical claims. Log-linear regression models were used to estimate unadjusted and adjusted prevalence rate ratios (PRR) and 95% confidence intervals (CIs). The same method was used to test for an interaction between preventive dental care utilization and CC status. Results: The mean age of study participants was 15.3 (SD 1.20) years, 49.2% were male, 49.6% were Hispanic, and 6.7% had chronic conditions. Of the adolescents evaluated, 33.8% utilized preventive dental care and 66.7% had dental caries experience (DMF>= 1). There were no significant differences in dental caries experience between adolescents who did and did not utilize preventive dental care (PRR: 0.96, 95% CI: 0.60,1.52; P=.85). No significant interaction was found between preventive dental care utilization and chronic condition status (P=.27). Conclusions: Our data failed to show an association between preventive care and caries experience for Medicaid-enrolled adolescents nor did we find evidence for CC status as a modifier. These findings suggest that preventive dental care is an unlikely explanation for poor oral health outcomes in publicly insured adolescents. Continued clinical and policy efforts are needed to improve the oral health of adolescents in Medicaid.