Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs

Resident: Adam J. Bottrill
Date: 29JUL10
Region: Providence
Article title: Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs
Author(s): Savage, M. et al
Journal: Pediatrics
Page #s: pp. 417-423
Year: 2004
Major topic: Early Preventative Visits
Minor topic(s): NA
Type of Article: Investigational Study
Main Purpose: To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children.

Key points in the article discussion:

I. Methods:
A. 53,591 Medicaid-enrolled children born in 1992. 9204 continuously enrolled for 5 years and met inclusion criteria. The cohort study monitored these children longitudinally until their 5th birthday in 1997.
B. Mother's mean age: 23. Mother's mean educational level: grade 11.
C. First Dental Visit
1. 1/3 of these children received 1st dental visit during the study (seriously?)
2. <1yo: 23, 1-2yo: 249, 2-3yo: 465, 3-4yo: 915, 4-5yo: 823

II. Results and Discussion:
A. Children with "1st visit" <1yo were more likely to have subsequent PREVENTATIVE visits. Those with later "1st visits" were more likely to have subsequent RESTORATIVE and EMERGENCY visits.
B. Average cost of dental care during the study period (by age of "1st visit")
1. <1yo: $262, 1-2: $340, 2-3: $450, 3-4: $492, 4-5: $547.
C. It was found that total dental vists of all types increased with those children who lived in counties where there was increased access to care.

III. Limitations:
A. This was a retrospective cohort study with possible selection bias.... however, a prospective study with the same scope would be very difficult.
B. This study is based on claims... NOT actual caries rate.

IV. Conclusions:
A. Broad generalizations of these findings should be made with caution.
B. Under the conditions of this study, however...
1. Preschool-aged children were more likely to receive dental services of all types in counties with increased concentration of dentists.
2. Preschool-aged children from minority groups had greater difficulty in finding access to dental care,
3. Preschool-aged children who had an early preventive appt were likely to use preventive services subsequently.
4. Preschool-aged children who used early preventive care incurred fewer dentally related costs, compared with children who began care at a later date.

Assessment of article: Great article. I know there are weaknesses and limitations, however I see the conclusions as "ammunition" to help us convince parents to bring their kids in EARLY! No shenanigans here.