Effects of Expanding Preventive Dental Care in Medical Offices for Young Children Covered by Medicaid

In January 2000, North Carolina initiated a comprehensive preventive dental program for Medicaid-enrolled children from birth through 35 months of age (Into the Mouths of Babes, or IMB) offered in medical offices by providers who completed continuing medical education related to these services. This study assesses the effects of the IMB program, which included the application of a fluoride varnish to children's teeth in addition to screening, risk assessments and counseling, on access to preventive dental care and subsequent use of restorative dental treatments.

The analysis uses Medicaid claims and enrollment data from the NC Division of Medical Assistance for all children from 6 through 35 months of age who were enrolled in Medicaid from January 2000 through June 2003. Regression analyses are used to compare subgroups of children receiving four or more of a possible six IMB visits with children receiving no IMB visits to determine whether the IMB program results in reduced use of caries-related treatment.

The IMB program led to a substantial increase in access to dental care without reducing preventive care by dentists. Despite referrals to treat identified disease, the program reduced the need for dental treatment by 3 years of age among children with four or more IMB visits. Analysis during the implementation phase means the high magnitude of referrals for existing disease could decrease over time. Because a number of visits are required to obtain the full preventive benefits, the cost-effectiveness of the program ultimately rests on reductions in dental restorations beyond age 3.