Oral Health Prevention in a Cohort of Pediatric Ohio Medicaid Beneficiaries

Background: Fluoride varnish application in medical settings was introduced more than twenty years ago as a way to prevent early childhood caries in very young children. Early studies demonstrated its benefits, while contemporary evaluations paint a less clear picture. The United States Preventive Services Task Force maintains fluoride varnish application in medical settings as a “B” recommendation. The intervention has not been studied in our state, so we sought to compare dental utilization metrics between children who did and did not receive fluoride varnish from a primary care provider (PCP) in a cohort of pediatric Medicaid beneficiaries residing in central and southeast Ohio.

Methods: We used Partners for Kids administrative and billing claims from 2015-2019. We summarized user type, rural residence (metropolitan vs non-metropolitan as defined using USDA rural-urban continuum codes), and enrollment category (disability, adoption/foster care, child and family enrollment) according to oral health utilization outcomes: types of dental visits (diagnostic, preventive, caries-related treatment, and dental general anesthesia (DGA)), and expenditures per visit. User type was defined by where the child received fluoride varnish (dentist-only versus dentists and PCPs). We report visit-level descriptive statistics here.

Results: Dentist-only users were more frequently enrolled by disability or adoption/foster care (1.6% and 3.4% vs. 0.6% and 1.1%, respectively) and more frequently from non-metropolitan areas (33.4% vs. 15.5%) compared to users who received fluoride varnish from dentists and PCPs. Dentist-only users had a higher frequency of DGA visits (5.7% vs. 3.0%), higher frequency of caries-related treatment visits (16.6% vs. 9.3%), and higher expenditures per dental visit ($180.77 vs. $107.18). Children enrolled by disability had a higher frequency of DGA visits compared to adoption/foster care or child and family enrollment (6.3% vs. 3.9% vs. 3.7%). Children who lived in non-metropolitan areas had lower frequency of fluoride varnish receipt in PCP offices (19.3%), and higher frequency of DGA (5.2%) compared to their metropolitan-area peers (33.3%, and 3.4%).

Conclusion: Oral health utilization disparities, including the receipt of fluoride varnish in medical settings, persist by enrollment category and rural residence. Receipt of fluoride varnish from PCPs may be associated with less frequent use of DGA and lower expenditures at oral health visits. However, additional analysis is needed to account for identified disparities so that targeted interventions can be developed and studied.