Factors Associated with Receiving Treatment for Dental Decay for Medicaid- Enrolled Children Under 12 Open Access
Zilversmit, Leah (2012)
Abstract
Objectives: Researchers have found that Medicaid-enrolled
children face barriers to
dental care. Several Medicaid-enrolled children are screened for
tooth decay through the
IDPH I-Smile program. We identified children younger than twelve
with decay and
determined the characteristics of children seeking treatment for
decay. The purpose of
this study is (1) to determine how many Medicaid-enrolled children
younger than 12
years who screened positive for decay obtained treatment for dental
caries within six
months and (2) to identify the factors associated with children not
receiving dental
treatment.
Methods: We linked program data for screened children to
Medicaid claims for dental
treatment (N=16,109) and we performed multivariate logistic
regression to assess the
association of sociodemographic characteristics to receipt of
treatment for children who
screened positive or negative for decay.
Results: Eleven percent of children had decay and nearly 24% of
children with decay had
a Medicaid claim for treatment. Being of school age (OR: 1.484,
p-value=0.001) and not
having a dental home (OR: 1.904, p-value<0.0001) were positively
associated with not
seeking dental treatment. Of the 14,293 children screening negative
for decay, 3.5% had
a Medicaid claim for caries treatment and they were more likely to
be school-aged (OR:
0.656, p-value <0.0001).
Conclusions: Children older than five and without a dental home
are more likely to go
untreated for caries. It will be critical that programs such as
I-Smile™ link at-risk
children to dental homes.
Table of Contents
TABLE OF CONTENTS
Chapter 1:
Introduction.....................................................................................................1
Chapter 2: Review of
Literature........................................................................................5
Chapter 3:
Manuscript.....................................................................................................20
Title Page
..................................................................................................................................
20
Statement of
Contribution.......................................................................................................
21
Abstract
.....................................................................................................................................
22
Introduction
..............................................................................................................................
24
Methods
.....................................................................................................................................
26
Results
.......................................................................................................................................
30
Discussion..................................................................................................................................
33
Acknowledgments
....................................................................................................................
37
References
.................................................................................................................................
38
Figures and Tables
...................................................................................................................
41
Figure 1: Children younger than 12 screened for decay from
January to April 2010,
outcomes for first screening
...................................................................................................
41
Table 1: Descriptive analysis of children screening positive and
negative for decay in first
screening
................................................................................................................................
42
Table 2: Bivariate analysis of treatment for children screening
positive for decay in first
screening and receiving treatment
.........................................................................................
43
Table 3: Bivariate analysis of treatment for children screening
negative for decay in first
screening for receiving
treatment...........................................................................................
44
Table 4: Regression model describing odds of not receiving
treatment for children screened
positive and negative for decay
............................................................................................
45
Figure2: Median income and location of dental providers in Iowa,
2011 ............................. 46
Chapter 4: Discussion/Recommendations
......................................................................47
Appendices ........................................................................................................................58
Appendix A: Letter of Withdraw from IRB Committee ...................................................... 58
Appendix B: Child and Adolescent Risk Reporting System (CAReS) Form ..................... 59
Appendix C: Figures not included in Manuscript ................................................................ 61
Figure 3: Map of Public Health Regions
...............................................................................
61
Figure 4: I-Smile™ coordinators map
...................................................................................
62
Figure 5: Median income and location of dentists in 5 most
populated cities,
Iowa 2011
.............................................................................................................................
63
Figure 6: Licensed dentists within median family income census
tract per family
population
..............................................................................................................................
64
Figure 7: Iowa dentists and dental specialists
......................................................................
65
Figure 8: Percent distribution of time interval for children
treated within first six months
after screening, by positive or negative for decay, Iowa 2010
.............................................. 66
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