Preventive dental services in a home visiting program and the impact on children's dental utilization

Objectives: CHIP (Child Health Investment Partnership) of Roanoke Valley is a home visiting program that promotes children's health and family self-sufficiency. CHIP's Begin with a Grin program provides home-based dental anticipatory guidance and fluoride varnish for children 0-6 years of age. The purpose of this study was to examine the dental utilization of CHIP children with and without tooth decay. Methods: This study included children (N=205) enrolled in CHIP between Sept 2008 and March 2010. Tooth decay was the main effect variable using a calibrated visual exam measuring the presence of frank (d2) and non-cavitated decay (d1), as well as filled and missing teeth. The outcomes were dental utilization in Medicaid as measured by preventive and restorative treatment. Logistic regression models were run using SAS 9.3 to obtain the odds ratio contrasting CHIP children with decay vs. those without decay. Results: Of the 205 CHIP enrolled children, 49% had dental decay. A child enrolled in CHIP with tooth decay had a 3.88 times greater likelihood (95% CI 1.2-12.8) of having a preventive claim, and a 3.96 times greater likelihood (95% CI 2.0-8.0) of having a restorative claim then a CHIP enrolled child with no dental decay adjusting for the child's age. Conclusions: There was a significant increase in dental utilization for children in the CHIP program with tooth decay compared to those without decay. A home visiting model can introduce children and their families to the establishment of a dental home and appropriate utilization of dental services in Medicaid.