Engaging High-Risk Pediatric Medicaid Populations in School-Based Dental Caries Prevention
Overview
School-based caries prevention programs (SCPPs) targeting high-risk pediatric Medicaid populations show promise in reducing dental caries and emergency department visits. However, participation tends to be higher among children with prior dental care utilization, potentially biasing program reach and effectiveness estimates.
Background
Dental caries remains the most common disease among children aged 2 to 5 years, affecting over 20%. Despite declines in untreated decay over decades, recent trends have plateaued, with increasing emergency department admissions for nontraumatic dental conditions in children under 14. School-based caries prevention programs provide preventive and therapeutic dental care, such as sealants and silver diamine fluoride, which reduce caries risk by approximately 30%. Parental consent requirements may limit participation among the highest-risk children, raising concerns about selection bias and program reach.
Data Highlights
Measure
Value
Children aged 2-5 years affected by caries
>20%
ED admissions for nontraumatic dental conditions (2019)
27.3 per 10,000 children <14 years
ED admissions for nontraumatic dental conditions (2022)
43.1 per 10,000 children <14 years
Number of schools in CariedAway study
47 primary schools
CariedAway participants matched to Medicaid data
2632 children aged 5-13 years
Percentage of CariedAway participants enrolled in Medicaid
~60%
Reduction in caries risk with SCPPs
~30%
Key Findings
Children participating in SCPPs were more likely to have had dental care utilization in the prior year compared to nonparticipants.
Parental informed consent requirements may contribute to selection bias, limiting participation of high-risk, dental-averse children.
SCPPs delivering preventive treatments such as silver diamine fluoride and sealants effectively reduce caries risk by approximately 30%.
Emergency department visits for dental conditions in children have increased recently, highlighting the need for effective preventive programs.
Linkage of SCPP participation data with Medicaid claims enabled assessment of disparities and program reach in a high-risk urban population.
Most CariedAway schools were located in Bronx neighborhoods with high Medicaid enrollment and socioeconomic risk factors.
Clinical Implications
Clinicians and public health practitioners should recognize that school-based caries prevention programs may underrepresent children at highest risk due to consent and participation barriers. Strategies to improve engagement of dental-averse families are essential to maximize program impact and reduce costly emergency department visits. Integrating Medicaid data linkage can help identify gaps in care and tailor interventions to reach underserved populations.
Conclusion
School-based caries prevention programs are effective in reducing dental caries among high-risk pediatric Medicaid populations but face challenges in engaging the highest-risk children. Addressing participation barriers is critical to enhance program reach and reduce disparities in oral health outcomes.
References
NYU School of Medicine/CariedAway Study/2023 -- Strategies for Engaging High-Risk Pediatric Medicaid Populations in School-Based Dental Caries Prevention Initiatives
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