Dental Care Utilization for Children with Special Health Care Needs in Washington State’s Access to Baby and Child Dentistry Program

Abstract

Objectives: To identify potential disparities affecting young children with special health care needs (CSHCN) within public dental programs by evaluating preventive dental care utilization rates in Washington State’s Access to Baby and Child Dentistry (ABCD) Program. Methods: This is a cross-sectional analysis of 2012 Medicaid data from Washington state. The data was obtained from the Washington State Health Care Authority and included children under age six who were enrolled in the Medicaid program in 2012 for 11-12 months (N=206,488). Medical diagnosis codes (from hospital, inpatient, and outpatient data) and Medicaid eligibility files were used to determine each child’s special needs status. The outcome was utilization of preventive dental services, as determined by Current Dental Terminology (CDT) codes. Modified Poisson regression was used to estimate both crude and adjusted prevalence rate ratios with 95% confidence intervals (CI). All analyses were conducted using Stata 13 for Windows (StataCorp LP, College Station, Texas, USA). Results: There were 58,511 children determined to have SHCN (28.3%). A total of 114,570 children had at least one preventive dental visit in 2012 (55.5%). Age, SHCN status, Ethnicity, Race, and county Health Professional Shortage Area (HPSA) were statistical confounders and included in the adjusted Modified Poisson regression analysis. The adjusted analysis revealed CSHCN were 1.04 times more likely to utilize preventive dental care than their typically developing peers (95% CI: 1.03, 1.05, p < 0.001). Other factors associated with increased likelihood of preventive dental care use included: Hispanic ethnicity, preventive medical care use, older age, and living in an area not classified as a Health Professional Shortage Area (HPSA) (p < 0.001 for all). Conclusions: Medicaid-enrolled CSHCN in Washington state are slightly more likely to receive preventive dental services than children without SHCN. Other factors associated with increased likelihood that a child utilized preventive dental care included older age, having preventive medical care, not residing in a dental HPSA, and Hispanic ethnicity. Efforts from state organizations, providers, and aid groups can focus on ensuring that all children served by the ABCD program receive appropriate preventive dental care.