Role of geographic proximity to dentists in children's access to dental care

Improving children's access to dental care is a commonly stated policy goal for improving their oral health. Distance to providers is a significant predictor of healthcare utilization. However, not much is known about the effects of geographic proximity to dentists on dental care use. This study evaluates the effects of children's distance to the nearest dentist on dental care use including preventive care measured by comprehensive oral evaluation and dental treatments classified into major (e.g., endodontic treatment and crowns) and minor treatments (e.g., surface fillings) and tooth extractions. We study a sample of about 45,000 children born in Iowa between 2000 and 2006 and enrolled in Medicaid. Children's addresses and dental care use are measured through 2009 from the Medicaid enrollment and claims files. Data on dentists providing care to Medicaid patients and their addresses are obtained from the Iowa Department of Human Services. We employ GEE-type logistic regression adjusting for demographic factors, year, and county-level socioeconomic and healthcare characteristics from the area-resource-file. We find that increasing distance to the nearest Medicaid-accepting dentist significantly reduces children's use of comprehensive oral evaluations, but has no effects on dental treatments (major/minor or extractions). A 10-mile increase in distance is associated with 7.4% decrease in the probability of obtaining comprehensive oral evaluations. Given the importance of comprehensive dental evaluations for maintaining oral health and preventing future dental problems, the study identifies geographic proximity to dental care providers as an important factor for improving children's access to preventive care and their oral health outcomes.