When Do Babies Go to Dentist on Medicaid
Am J Public Wellness. 2013 February; 103(2): 347–354.
Human relationship Between Medical Well Baby Visits and Beginning Dental Examinations for Young Children in Medicaid
Donald L. Chi, DDS, PhD, 
Elizabeth T. Momany, PhD, Michael P. Jones, PhD, Raymond A. Kuthy, DDS, MPH, Natoshia M. Askelson, PhD, MPH, George L. Wehby, PhD, and Peter C. Damiano, DDS, MPH
Abstract
Objectives. We examined the relationship betwixt preventive well baby visits (WBVs) and the timing of showtime dental examinations for young Medicaid-enrolled children.
Methods. The written report focused on children born in 2000 and enrolled continuously in the Iowa Medicaid Programme from birth to age 41 months (n = 6322). The main predictor variables were number and timing of WBVs. The outcome variable was timing of kickoff dental test. We used survival analysis to evaluate these relationships.
Results. Children with more WBVs between ages 1 and 2 years and ages 2 and 3 years were 2.96 and ane.25 times as likely, respectively, to have earlier starting time dental examinations equally children with fewer WBVs. The number of WBVs before historic period 1 year and the timing of the WBVs were non significantly related to the outcome.
Conclusions. The number of WBVs from ages 1 to iii years was significantly related to earlier first dental examinations, whereas the number of WBVs before age i year and the timing of WBVs were not. Future interventions and policies should actively promote offset dental examinations by historic period 12 months at WBVs that take place during the first year of life.
The 2011 Found of Medicine study Improving Admission to Oral Health Care for Vulnerable and Underserved Populations highlighted the persistent disparities in dental intendance access that touch young children.ane Fewer than 5% of children have a dental examination by age 12 months equally recommended by the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.2–5 A cornerstone in prevention, dental examinations provide dentists the opportunity to deliver hazard-based anticipatory guidance to caregivers, permit for less invasive restorative interventions when illness is already present, and are a source of preventive care provided throughout babyhood.half dozen,7
Dental examinations are part of a comprehensive strategy to preclude early on childhood caries, a type of tooth decay that affects children aged younger than 6 years.8 Early childhood caries is the most common pediatric disease in the The states and is a public health problem that disproportionately affects low-income children.ix–eleven A seventy% increase occurred in the prevalence of untreated early babyhood caries amongst low-income children aged 2 to v years between 1988 to 1994 and 1999 to 2004.12 Thus, it is a growing trouble. Untreated early childhood caries can atomic number 82 to pain, infection, hospitalization, and in rare cases death13–15 and is associated with subsequent molar decay in the permanent teeth, poor school attendance, and low quality of life—consequences that accept deleterious effects throughout the life course.16–xviii
From a public health perspective, earlier get-go dental examinations are likely to help forestall early on childhood caries among depression-income children enrolled in country Medicaid programs.xix Ane report reported that before kickoff dental examinations for Medicaid-enrolled children reduce the need for invasive restorative treatments and are cost effective.2 The barriers to early start dental examinations include dentists' unwillingness to treat immature children, limited caregiver noesis of when to take their kid to a dentist, medical provider dubiety of when to refer young children, and low Medicaid reimbursement.20–22
Although few children have a first dental test past age 12 months, nearly have multiple well babe visits (WBVs) by this historic period.23 Previous studies accept reported associations between preventive medical and dental care utilise as well as between preventive medical care use and the timing of first dental visits for Medicaid-enrolled children aged three to 8 years.24–26 However, no study has focused on the human relationship betwixt WBVs and starting time dental examinations for young Medicaid-enrolled children younger than 3 years, with an emphasis on how the frequency and timing of WBVs are related to the timing of starting time dental examinations.
In this study, we adapted a sociocultural oral health disparities model presented by Patrick et al.27 to examination 3 hypotheses: (1) young children with more WBVs are more likely to have earlier first dental examinations than those with fewer WBVs, (2) immature children with earlier commencement WBVs are more probable to take before commencement dental examinations, and (3) other social and behavioral factors are associated with earlier first dental examinations. We focused on WBVs because of the conceptual link between medical and dental care use.24–26 These first two hypotheses are based on the premise that WBVs are proxies for wellness-related behaviors and behavior influenced past the motivations, values, and personal preferences for earlier start dental examinations by caregivers.27 The third hypothesis is based on the premise that factors at the arrangement, community, and family level make upward the milieu in which decisions are made by caregivers to seek dental intendance for their child.27 The data gleaned from this report could help identify specific points in the WBV periodicity schedule at which future population-based interventions aimed at getting infants to the dentist before for their first dental test could be implemented.
METHODS
This study was a retrospective cohort report based on Iowa Medicaid enrollment and claims data (2000–2008) and was approved by the Academy of Iowa institutional review board.
Study Participants
In calendar year 2000, 14 364 children were born and were enrolled in Iowa Medicaid at birth. We excluded 7611 children who were enrolled less than 41 continuous months to allow for consummate identification of each of the 10 recommended WBVs (run into Principal Predictor Variables department). In addition, we excluded 133 children who received dental care from a customs health middle to focus on children seen in private practice clinics.
Because our interest was on prevention-oriented dental examinations rather than treatment-driven visits, nosotros also excluded children who received whatever restorative dental care before the first test (north = 170) and those who received restorative dental intendance merely no examination (due north = 128). The concluding study population consisted of children born in calendar year 2000 who were enrolled for 41 or more continuous months starting from birth and who received dental care from private practise dental clinics (n = vi,322).
Study Variables
We organized model covariates into five domains (Figure 1): ascribed factors (immutable private-level variables), proximal factors (modifiable individual-level variables), immediate factors (household-level mediators betwixt proximal and intermediate variables), intermediate factors (customs-level variables), and distal factors (arrangement-level variables).
Conceptual model of relationship betwixt well baby visits and timing of first dental examinations for Medicaid-enrolled children.
Note. Dotted pointer indicates potential mediating pathway not evaluated in current study.
Source. The 5 model domains under which covariates were organized are based on Patrick et al.27
Nosotros conceptualized the predictor variables and the outcome measure equally proximal factors, and they reverberate the hypothesized link between medical and dental care use.24–27
Main Predictor Variables
The 2 sets of predictor variables were both proximal factors: (one) the full number of WBVs from nascence to age 41 months (WBV frequency) by catamenia and (2) the age at which the kickoff WBV took place (timing of the first WBV). WBVs were identified from claims files using the following International Classification of Diseases, Version ix, Clinical Modification (ICD-9-CM)28 and Current Procedural Terminology (CPT) codes: V20.2, V70.0, V70.3, V70.v, V70.6, V70.eight, V70.9, 99381, 99382, 99391, 99392, and 99432.29
Nosotros used the 2000 American University of Pediatrics WBV schedule to assess whether a child received each of the following ten recommended WBVs (no or yes): ane month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, and 36 months.iv Nosotros calculated the age at which each WBV took identify by subtracting the child's engagement of birth from the WBV date of service and applying previously published historic period ranges around each WBV to let flexibility in when WBVs occurred.xxx For case, we classified a kid who had a WBV betwixt age 7 days and younger than 1 month as having had the 1-calendar month WBV (Tabular array ane).
Table 1—
Age Ranges Applied to Each Well Baby Visit by Menses and American Academy of Pediatrics Well Baby Visit Schedule Recommendations
| WBV Schedule4 | Age Ranges30 |
| Period 1 | |
| Total no. WBVs past age 1 y (minimum 0, maximum five) | |
| 1 mo | vii d–< 1 mo |
| 2 mo | i mo–2 mo |
| four mo | 3 mo–4 mo |
| vi mo | 5 mo–vii mo |
| nine mo | viii mo–10 mo |
| Menses 2 | |
| Full no. WBVs betwixt age 1 and 2 y (minimum 0, maximum iii) | |
| 12 mo | 11 mo–thirteen mo |
| 15 mo | 14 mo–xvi mo |
| 18 mo | 17 mo–nineteen mo |
| Menses three | |
| Total no. WBVs betwixt age 2 and 3 y (minimum 0, maximum ii) | |
| 24 mo | 20 mo–29 mo |
| 36 mo | 30 mo–41 mo |
To measure WBV frequency, we classified each WBV into 1 of 3 periods on the basis of historic period ranges relevant in dentistry and summed them (Table 1): number of WBVs before age ane yr (period 1, age at which main incisors begin to erupt; equally many as 5 visits possible), number of WBVs between ages one and ii years (period two, age at which primary molars begin to erupt; as many as 3 possible visits), and number of WBVs between ages 2 and 3 years (period iii, age at which all primary teeth have erupted; as many as ii visits possible).
The timing of the get-go WBV consisted of 2 variables: (one) whether the offset WBV took place by fourth dimension t (a fourth dimension-dependent indicator variable) and (2) the interaction between the kickoff variable and the exact historic period (in days) at which the first WBV took place.
Main Outcome Measure out
The main outcome measure out, a proximal cistron, was the timing of the child'southward first dental examination measured as the starting time prevention-oriented dental examination. Nosotros used the post-obit American Dental Association Current Dental Terminology Codes to identify dental examinations from the claims files: D0150 (comprehensive dental exam) or D0120 (periodic dental examination).31 We included the D0120 lawmaking considering some dentists apply this to lawmaking young children's starting time dental examination rather than the more advisable D0150.
Model Covariates
There were viii additional model covariates organized into the following domains:
-
Ascribed factors, modeled as confounders: kid'southward sex activity (male or female); child's race, a gene related to the timing of dental visits for children,32 equally reported by the child's caregiver (White, non-White, or missing); whether the child was at adventure for developing a chronic condition (no or yes), a measure developed in consultation with a pediatrician with expertise in chronic weather condition (John Neff, MD, personal communication, Nov eighteen, 2010; defined as an ICD-9-CM, CPT, or Healthcare Common Procedure Coding System codes indicating ventilator use, gastrostomy, tracheotomy, premature birth, low nascence weight, infantile seizures, or newborn apnea during the starting time xvi months of life)26; and whether the child was eligible for Medicaid through the Supplemental Security Income Program for 6 or more months during the first yr of life (no or yep), a mensurate of chronic condition severity.33
-
Proximal factor: whether the child saw unlike medical providers for WBVs (no or yes), a mensurate of the caregiver'south preference for or power to obtain child health care services consistent with the medical domicile concept.34
-
Firsthand factor: whether the child'southward female parent used whatsoever preventive dental care 12 months before the child was built-in (no or yes), a proxy for the caregiver'south preferences for preventive dental care.35
-
Intermediate cistron: rurality, a four-level variable based on the 2003 US Department of Agronomics Rural and Urban Continuum Codes associated with the kid'southward residence (rural, urban nonadjacent to metropolitan, urban adjacent to metropolitan, metropolitan), which measures the physical, social, and economic resources bachelor within the community.26
-
Distal factor: whether the kid lived in a dental Health Professional Shortage Expanse (no or yep), a measure of the dentist resources bachelor at the organization level.26
Statistical Analyses
We used survival assay to test our study hypotheses. Data were censored for children with no exam past age 41 months, the end of the study period. For the survival analyses, children were part of the risk set until their first dental examination. Before running our regression models, nosotros evaluated the proportional hazards assumption using time-dependent covariates in the form of {covariate * [log(time) − hateful log(time)]}.36 For whatsoever variable that violated this assumption, we included both the main effect and the time-dependent covariate in the model. We ran 3 multiple-variable Cox proportional hazards regression models (α = .05) that included the following as time-dependent variables: (1) WBV frequency across 3 periods, (two) timing of the kickoff WBV, or (3) both WBV frequency and the timing of the first WBV. Because we establish no differences beyond the models, we reported run a risk ratios and 95% confidence intervals from model 3. We completed all analyses using SAS version nine.three (SAS Plant, Cary, NC).
RESULTS
The proportions of boys and girls in our written report were near equal (49.5% and 50.five%, respectively; Table ii). Most children were White (76.vi%), 20.2% were non-White, and 3.2% had unknown or missing race/ethnicity. About 1 in 3 children were at risk for developing a chronic condition, and two.ane% were enrolled in Medicaid through the Supplemental Security Income Programme. Simply v.8% of children saw the aforementioned medical provider for WBVs. Nearly sixteen% of children had a mother who used preventive dental intendance prenatally. Finally, 55.five% of children lived in a metropolitan surface area, and 65.5% lived in a dental Health Professional Shortage Area.
TABLE 2—
Descriptive Data on Study Population of Children in the Iowa Medicaid Program (northward = 6322): 2000–2008
| Model Covariate | No. (%) |
| Ascribed factors | |
| Sex | |
| Female | 3129 (49.v) |
| Male | 3193 (50.v) |
| Race | |
| White | 4842 (76.6) |
| Not-White | 1277 (20.two) |
| Missing | 203 (3.2) |
| At run a risk for developing a chronic condition | |
| No | 4261 (67.four) |
| Yes | 2061 (32.6) |
| Eligibility for Medicaid through the Supplemental Security Income Program | |
| No | 6191 (97.9) |
| Yes | 131 (ii.ane) |
| Proximal factor | |
| Saw different medical providers for well baby visits | |
| No | 366 (five.8) |
| Yeah | 5956 (94.two) |
| Immediate factor | |
| Mother used any preventive dental care in the 12 mo before the child was born | |
| No | 5320 (84.two) |
| Yep | 1002 (15.eight) |
| Intermediate factor | |
| Rurality | |
| Metropolitan | 3507 (55.v) |
| Urban adjacent to metropolitan | 1227 (nineteen.four) |
| Urban nonadjacent to metropolitan | 1217 (xix.3) |
| Rural | 371 (5.9) |
| Distal factor | |
| Lived in a dental Health Professional Shortage area | |
| No | 2178 (34.5) |
| Yep | 4144 (65.v) |
Well Baby Visits and Showtime Dental Examinations
All children had at least i WBV during the first 41 months of life. The second-month WBV was the nearly frequently received WBV (85.6%) and the 36th-month WBV was the least frequently received (41.7%; information not shown).
In terms of frequency of WBVs, 55.1% of children had 4 or 5 WBVs in menses 1, 64.seven% had 2 or 3 WBVs in menstruation 2, and 74.3% had i or ii WBVs in period iii (data not shown). Equally for the timing of the first WBV, 57.ane% of children had their start WBV by historic period 30 days and 24.viii% had information technology betwixt historic period 31 days and historic period 60 days. The remaining eighteen.one% of children had their commencement WBV after age 61 days merely before age 42 months.
Fewer than ii% of children had a commencement dental examination by historic period 12 months and about 25% had an examination before age iii years (information not shown). Virtually 10% of children had their first dental examination after age 3 years only before age 41 months and 35% had an examination afterward age 41 months. Nearly 30% of children had no get-go dental examination.
Cox Regression Model
2 variables—the number of WBVs in menstruum 2 and whether the child saw different medical providers for WBVs—violated the proportional hazards assumption (P = .01 and P = .01, respectively). Thus, we included the primary issue and time-dependent forms of both covariates in the regression models.
Children with more than WBVs in period 2 (between ages i and 2) and period 3 (between ages 2 and 3) were two.96 and 1.25 times as probable to accept earlier first dental examinations (Table 3). WBV frequency in catamenia 1 (between birth and age 1) and the timing of first WBV were not related to the timing of examinations.
Tabular array 3—
Final Cox Proportional Hazards Regression Model for Fourth dimension to First Dental Test for Medicaid-Enrolled Children (n = 6322) in Iowa: 2000–2008
| Model Covariate | Hazard Ratio (95% CI) | P |
| Chief predictor variables | ||
| WBV frequency | ||
| Flow ane | 0.97 (0.93, 1.02) | .203 |
| Period 2 | 2.96 (1.41, half-dozen.15) | .004 |
| Fourth dimension-dependent covariate: Period 2 * [log(time) − hateful log(fourth dimension)] | 0.76 (0.63, 0.93) | .006 |
| Period 3 | ane.25 (1.14, 1.36) | <.001 |
| Age at first well baby visit | ||
| Charge per unit of the commencement WBV | 6.07 (0.79, 46.65) | .083 |
| Interaction betwixt the rate of the starting time WBV and the time at which the outset WBV took place | one.00 (0.99, 1.01) | .64 |
| Ascribed factors | ||
| Sex activity | .243 | |
| Female person | 0.95 (0.86, i.04) | |
| Male (Ref) | 1.00 | |
| Race | ||
| White (Ref) | 1.00 | |
| Not-White | one.fourteen (1.02, one.28) | .02 |
| Unknown or missing | 1.16 (0.89, 1.53) | .276 |
| At risk for developing a chronic condition | .443 | |
| No (Ref) | 1.00 | |
| Yes | 0.96 (0.87, one.07) | |
| Eligibility for Medicaid through the Supplemental Security Income Programme | .281 | |
| No (Ref) | 1.00 | |
| Yep | 0.82 (0.57, 1.18) | |
| Proximal factors | ||
| Saw different medical providers for WBVs | .001 | |
| No (Ref) | one.00 | |
| Yes | 0.10 (0.02, 0.41) | |
| Fourth dimension-dependent covariate: Saw different medical providers for WBVs * [log(time) − mean log(fourth dimension)] | 0.56 (0.38, 0.83) | .004 |
| Immediate factor | ||
| Mother used any preventive dental intendance in the 12 mo before the child was born | <.001 | |
| No (Ref) | 1.00 | |
| Yep | 1.40 (i.25, i.57) | |
| Intermediate factor | ||
| Rurality | ||
| Metropolitan (Ref) | one.00 | |
| Urban adjacent to metropolitan | 1.00 (0.89, ane.fourteen) | .956 |
| Urban nonadjacent to metropolitan | 1.05 (0.93, 1.19) | .458 |
| Rural | 1.16 (0.96, i.41) | .133 |
| Distal factor | ||
| Lived in a dental Wellness Professional Shortage Expanse | .207 | |
| No (Ref) | 1.00 | |
| Yes | 0.94 (0.85, 1.04) | |
3 other model covariates were significantly related to earlier first dental examinations: not-White race, whether the child saw dissimilar medical providers for WBVs, and whether the child's mother used preventive dental care prenatally. Non-White children were 1.14 times as likely to have before first dental examinations equally White children (P = .02), whereas those who saw different medical providers for WBVs were less likely to have earlier examinations (take chances ratio = 0.10; P = .001). Children whose mothers used preventive dental intendance prenatally were 1.40 times as likely to have an before examination as children whose mothers did not (P < .001).
DISCUSSION
This is the starting time study, to our knowledge, to examine the relationship between the frequency and timing of WBVs and the timing of first dental examinations for Medicaid-enrolled preschool-aged children. Nosotros had 3 principal findings.
Commencement, we tested the hypothesis that children with more WBVs during 3 periods of early childhood would have earlier beginning dental examinations. Just between ages 1 to 2 and two to 3 years were more WBVs significantly associated with earlier examinations. These findings are consistent with previous work suggesting significant relationships betwixt preventive medical and preventive dental intendance use24,25 and start preventive dental visits26 for Medicaid-enrolled children. Conversely, the number of WBVs received before historic period 1 yr was non meaning. There are three possible reasons: (1) primary (baby) tooth teeth brainstorm erupting around age 1 year, which may likewise be the historic period at which physicians brainstorm to innovate the importance of dental examinations to caregivers37; (2) mothers may be more receptive to the message of first dental visits afterward children have more of their teeth; and (three) it takes time for dental disease to manifest clinically. The menses later age one yr is when physicians may beginning find dental illness, at which fourth dimension dental referrals for treatment get necessary.
Second, we tested the hypothesis that children with an earlier first WBV would as well accept an before first dental examination. We found that the timing of the showtime WBV was not related to the timing of the first exam. Although this variable is conceptually relevant, the reason information technology failed to attain statistical significance in our model may be related to low variance. More than ninety% of children had their first WBV by historic period 3 months, and 99% had their outset WBV by age 11 months.
Third, nosotros tested the hypothesis that other social and behavioral factors would exist related to the timing of first dental examinations, and we identified 3 of import factors. First, non-White children were significantly more likely to have earlier first dental examinations than were White children. Previous studies have suggested race- and ethnicity-based variation in dental care employ.32,38,39 Before first dental examinations for non-White children may point greater levels of dental disease and caregiver motivation to take their kid to the dentist, although this interpretation requires verification in a future study. Second, children who saw the same medical provider for WBVs had significantly before kickoff dental examinations, which suggests boosted benefits associated with having a usual source of medical care.38 Seeing the same medical provider increases the likelihood of consistent anticipatory guidance and may facilitate enhanced communication between caregivers and pediatricians.34,40 Third, children whose mothers used preventive dental care prenatally were significantly more probable to have earlier examinations. A possible explanation is that these mothers may larn about the importance of infant oral health from their dentist. Notwithstanding, cognition gaps among dentists make this unlikely.41–43 A more plausible explanation is that these caregivers have college levels of health literacy and a stronger preference for oral health,44,45 which interpret into prevention-oriented health behaviors and before first dental examinations for their children. This finding is consistent with previous work linking mother and child dental intendance use35 and supports policies aimed at ensuring dental homes for mothers both prenatally and postnatally.
In regard to our conceptual model, it appears that 1 proximal factor (whether the child saw different medical providers for WBVs) and i immediate gene (whether the child'southward mother used preventive dental intendance) were related to the timing of first dental examinations. We establish no significant differences across the intermediate factor (rurality) and the distal factor (living in a dental Health Professional Shortage Area). These findings suggest that the determinants of the timing of first dental examinations for young Medicaid-enrolled children are influenced by kid- and family-level factors rather than upstream community- and organization-level factors. Futurity studies should examine the potentially modifying role of upstream factors such as rurality and living in a dental Health Professional Shortage Area.
Our findings are relevant to the development and improvement of medical part–based interventions aimed at reducing oral wellness disparities in immature children, such every bit North Carolina'southward Into the Mouth of Babes Programme.46 Considering children are more likely to visit a doctor for preventive care than a dentist by age 12 months, WBVs are a point of intervention to train physicians and nurses to recommend first dental examinations for all children by age 12 months. Formal partnerships between medical and dental offices may facilitate the referral process and allow medical function personnel to follow upwardly with dentist referrals. In areas with dentist shortages or waiting lists for dental appointments, oral health screenings and direct preventive intendance in the form of fluoride varnish past physicians may exist the only care children receive until they are seen by a dentist. Although 46 state Medicaid programs reimburse physicians for applying fluoride varnish,47 Medicaid reimbursements solitary are not likely to create an incentive for medical offices to participate in formal oral health prevention programs.48 Medical role–based preventive interventions should contain intensive training to assistance medical providers overcome cognition barriers and increase their conviction in providing oral health–related anticipatory guidance.21,49
Limitations
Our study had 4 main limitations. The first is that our findings are only generalizable to children continuously enrolled in Medicaid from birth to age 41 months. The relationship between WBVs and first dental examinations for children who are intermittently enrolled in Medicaid may exist unlike. The second is the potential for option bias. Caregivers whose children have more WBVs may take stronger preferences for oral health and health in full general, which may induce a noncausal correlation between WBVs and dental examinations. Unobserved kid health factors may too confound this relationship. Future studies should collect data from caregivers to account for other potentially important behavioral factors (e.yard., perceived severity of dental illness, cocky-efficacy of obtaining care) associated with before first dental examinations. Instrumental variable and propensity score analytic methods may address selection, although both approaches take limitations that require careful consideration.50–53 Furthermore, boosted covariates from the distal, intermediate, and immediate domains demand to exist included. Third, children with earlier examinations may already take dental disease when they initially present at the dentist. In other words, disease rather than prevention may exist a driver of earlier showtime examinations, which conflicts with a primary prevention model. However, fewer than two% of children in our written report received restorative treatment on the same date as the first dental examination. In the time to come, clinical dental data would assistance to place the potential modifying role of illness. Fourth, the analyses were based on children built-in in 2000, which gives us a baseline perspective on how WBVs are related to first dental examinations. The American Academy of Pediatrics and Bright Futures began recommending in 2000 and 2007, respectively, that physicians assess a child'south oral health take chances starting at age half dozen months.iv,54 Examining the relationship betwixt WBVs and kickoff examinations over time may reveal how changes in clinical guidelines affect children'south dental intendance use.
Conclusions
Oral health is an integral part of the overall wellness and well-being of young children. Few children see a dentist by age 12 months, yet, which motivates efforts to place the factors related to earlier first dental examinations. In our study, more WBVs between ages 1 to 2 and 2 to 3 years were significantly associated with earlier first dental examinations. Although this finding provides boosted evidence for a relationship betwixt preventive medical and dental care use, information technology is cause for business because these WBVs occur past the recommended age at first dental examination of 12 months. In fact, simply ii% of children in our written report had an examination past age 12 months and fewer than i in 4 children had an examination by age 3 years. It is nearly worrisome that 30% of Medicaid-enrolled children had no examination even though all of these children had at least 1 WBV and 97.3% had more than than ane WBV. Earlier first dental examinations are not a panacea for disparities in oral wellness. All the same, they play an of import role in ensuring optimal oral wellness for young children. Additional research is needed to further sympathise the relationship between WBVs and first dental examinations with an emphasis on identifying the behavioral and social determinants of first dental examinations and uncovering the mechanisms that bulldoze these relationships. This knowledge tin and then be used to develop appropriate clinical and policy solutions aimed at optimizing the oral wellness of all young children.
Acknowledgments
This study was supported by the National Institute of Dental and Craniofacial Research (grants RC1DE020303 and K08DE020856).
We give thanks the Iowa Department of Homo Services for admission to Medicaid data; Rusty Heckaman, archivist at the American University of Pediatrics, for providing historical documents on preventive pediatric health intendance recommendations; and John Neff, professor of pediatrics at the University of Washington School of Medicine, for his help with operationalizing written report variables.
Portions of this study were presented at the International Clan of Dental Research meeting, San Diego, CA, March 14–19, 2011, and the National Oral Health Conference in Milwaukee, WI, Apr 30–May 2, 2012.
Human Participant Protection
This report protocol was canonical by the institutional review board at the University of Iowa.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558774/
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