By Kathryn Doyle
NEW YORK (Reuters Health) - Many kids on Medicaid are not receiving dental care, and those who do often first show up with a dental emergency, according to a new study.
Less than half of a group of four-year-olds the researchers followed had ever visited a dentist, and caregivers who neglected their own oral health tended to neglect that of their children too.
"We know that both good oral health and dental problems tend to cluster and co-occur in families," said Kimon Divaris, who led the study at the UNC School of Dentistry at the University of North Carolina at Chapel Hill.
According to the American Academy of Pediatric Dentistry, children should visit a dentist for their first check-up when their first tooth appears, or no later than their first birthday. The AAPD recommends check-ups every six months after that to prevent cavities and other problems.
Oral health is part of general health, and dental problems in young children have been linked to other negative consequences including discomfort and pain, reduced quality of life, failure to thrive, time lost both from school and parents' work and financial expenditures for families and the health system, Divaris told Reuters Health in an email.
Although doctors and dentists have worked to make dental care more accessible for all kids, parents and caregivers play an important role in when and whether kids on Medicaid see a dentist, the authors write in the journal Pediatrics.
"What we are still trying to figure out are the mechanisms that underlie these associations: are they social, economic, cultural, behavioral, genetic or a combination?" Divaris said.
The researchers accessed Medicaid data and caregiver interviews for 1,000 children with no previous dental visits in 2007 and used records to follow the children for two years. On average, kids entering the study were 16 months old.
Over the course of the study, 39 percent of the children saw a dentist for the first time. For more than one in seven of these, that first visit was for a dental emergency.
Kids who had oral health problems as 16-month-olds were more likely to visit a dentist, and were more likely to require emergency care during the study period.
But the analysis did not consider oral health screenings or preventive services provided by pediatricians, which certainly would qualify as improving oral health, said Justin Blackburn of the Department of Health Care Organization and Policy at the University of Alabama at Birmingham School of Public Health.
"We still need more research to understand the benefits of 'early entry into the dental care system' as well as barriers to the receipt of oral care," Blackburn told Reuters Health in an email.
The overwhelming majority of caregivers in this study were female, single and low-income. Kids whose caregivers neglected their own dental health were less likely to see a dentist, the authors wrote.
"Early, preventive visits are aligned with the establishment of a 'dental home'," said Divaris, where there's "an ongoing relationship between the dentist and the patient, and comprehensive oral healthcare is delivered in a continuously accessible, coordinated and family-centered manner."
Regular visits also help educate parents about oral hygiene, diet, cavity risk and preventive measures like fluoride varnishes, he said.
Because babies' teeth fall out, parents generally don't realize they're important, according to Jane A. Weintraub, dean of the UNC School of Dentistry.
Children develop tooth decay, toothache and infections, much of which is preventable with good dental care, she told Reuters Health in an email.
According to a 2010 U.S. study, 14 percent of three- to five-year-olds had untreated dental decay, including 25 percent of kids living below the poverty level.
Although the new study, and others before it, have found that individual characteristics of caregivers, like how much they care for their own teeth, predict whether or not the child will visit a dentist, there may be larger social forces at work, Divaris said.
There may not be enough dental providers in some communities, or little community support, or there may be an attitude of "dental fatalism," in which people assume getting cavities as a child is the norm and is accepted, he said.
These barriers can't easily be addressed, he added, but there are ways to reduce them.
Virtually all children will go to a pediatrician for check-ups and vaccinations, and pediatricians in that setting could perform oral health screenings, educate parents and refer them to dentists, he said.
In some places, school-based programs deliver oral health services without requiring parental involvement, he said.
"Actually, community water fluoridation is a great public health success story along these lines, where a proven measure is delivered in large population segments without relying on individuals' actions," he said.
He urged parents and caregivers not to wait for a problem to develop before taking their children to the dentist.
SOURCE: http://bit.ly/1npMiDN Pediatrics, online April 21, 2014.