Returns of early dental health prevention: The case of comprehensive oral evaluation

Early and consistent use of preventive dental care during childhood is commonly recommended for maintaining good oral health. However, there is little rigorous research using population-based data on the long term effects of such care. This study identifies the effects of using preventive dental care involving comprehensive oral evaluation on subsequent use of dental treatments during childhood and makes several novel contributions. The study employs a longitudinal design that only uses within-child variation in dental care over time to remove time-invariant unobservable confounders such as family background characteristics. Also, we evaluate whether preventive dental care effects last beyond the next year. Finally, we assess if these effects vary by child age. We employ a population-based sample of about 35,000 children involving those born between 2000 and 2006 in Iowa and enrolled in Medicaid. Children are followed through 2009. Preventive dental care and dental treatments are measured from Medicaid claims. Outcomes are subsequent uses of major dental treatments such as endodontic treatment and crowns, minor treatments such as surface fillings, and tooth extractions. Based on our conditional (fixed-effect) logit regressions, we find that preventive care is associated with substantial reductions (> 50%) in subsequent dental treatments at all ages between 2 and 8 years. The largest effects (>70% reduction) are for ages ≤5 years. Also, previous preventive care has long-lasting effects beyond the next year, conditional on more recent preventive care. The study finds large returns to dental health from early and consistent use of preventive dental care during childhood.