Treatment Gaps Among Young Medicaid-Enrolled Children with Tooth Decay in Pediatric Primary Care

Objective

To examine whether Medicaid-enrolled preschoolers with untreated decayed teeth received dental treatment within one year of enrollment and identify the factors associated with a treatment gap.

Methods

A retrospective cohort analysis of data from a cluster-randomized trial conducted in 18 community-based pediatric primary care practices in Northeastern Ohio (2017–2022). Treatment receipt was determined using Medicaid claims, with treatment gap defined as fewer teeth with treatment claims than teeth found on baseline exam with decay. Multivariable logistic regression assessed association of treatment gap with child age, sex, race/ethnicity, caregiver education, and number and location of baseline decayed teeth.

Results

Of 766 eligible children, 487 (63.6%) attended the dentist within one year. Among 155/487 (31.8%) with baseline untreated decay, 90/155 (58.1%) had a treatment gap. Odontograms visually showed that decay was concentrated on upper anterior and posterior teeth. A treatment gap was associated with a greater number of decayed posterior teeth (OR = 1.90, 95% CI: 1.60–2.30) and decayed anterior teeth (OR = 2.19, 95% CI: 1.51–3.39), both p < 0.001. Other socio-demographic variables were not significantly associated with a treatment gap.

Conclusion

More than half of Medicaid-enrolled children attending well-child visits had a dental treatment gap after 1 year. This pattern may reflect dentist’s hesitance to restore primary teeth nearing exfoliation and needing multiple dental visits to complete needed restorative treatment. To address this gap, non-surgical interventions such as silver diamine fluoride can be applied by pediatric primary care providers to control the bacteria and prevent disease progression.

What’s Known on This Subject

Dental caries is the most prevalent chronic childhood illness, disproportionately affecting low-income Medicaid-enrolled children. Despite barriers to dental access most research focuses on utilization rather than on whether children with untreated decay received needed treatment once they attend a dentist.

What This Study Adds

Among Medicaid-enrolled preschoolers attending well-child visits, 58.1% had a dental treatment gap for untreated decay. These findings underscore the need for greater adoption of nonsurgical silver diamine fluoride treatment that can be applied by medical professionals to close the gap.

Contribution Statement

Dr. David Selvaraj and Dr. Suchitra Nelson conceptualized and designed the study, drafted the initial manuscript, designed the data collection instruments, coordinated and supervised data collection, collected data, carried out the initial analyses, and critically reviewed and revised the manuscript.

Dr. Sarah Ronis drafted the initial manuscript and critically reviewed and revised the manuscript.

Dr. Jeff Albert conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analyses, and critically reviewed and revised the manuscript.

Dr. Johnie Rose conceptualized and designed the study and critically reviewed and revised the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.