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A new study suggests preventive dental care provided before the age of 2 is associated with a higher rate of dental visits and more frequent tooth decay-related treatment.
Everyone knows that caring for your child’s teeth is critical-but a new study has found another reason why early intervention is crucial.
Although the American Academy of Pediatric Dentistry recommends taking children to the dentist for their first dental checkup when their first tooth appears or before their first birthday, about 40 percent of children ages 2 to 5 have cavities, according to Parents magazine. In addition, at least 4 million preschoolers suffer from tooth decay, an increase of more than 600,000 kids in the last decade. To avoid these problems, researchers at the University of Alabama at Birmingham School of Public Health are taking a closer look at a group of children under the age of 2 enrolled in Medicaid in Alabama to determine if early preventive dental care may lead to more long-term care.
The retrospective study compared tooth decay-related treatment, visits and dental expenditures for children receiving preventive dental care from a dentist or primary care provider to those receiving no preventive dental care. The authors of the study analyzed data from 19,658 children in Alabama who were continuously enrolled in Medicaid from birth between 2008 and 2012.
Among the eligible children, 25.8 percent received preventive dental care from a dentist before age two. Forty-four percent of the children were black, 37.6 percent were white and 16.3 percent were Hispanic.
The study found that children who had received early preventive dental care from a dentist had more frequent subsequent caries-related treatment (20.6 percent vs. 11.3 percent), a higher rate of visits (0.29 vs. 0.15 per child-year) and greater dental expenditures ($168 vs. $87 per year). Preventive care delivered by a primary care provider did not significantly affect caries-related treatment use or expenditures.
The study did not include information on oral health behaviors like teeth brushing or water fluoridation. It also did not measure other benefits of preventive care, such as improved quality of life.
While the researchers concluded that they found no evidence of a benefit of early preventive dental care regardless of the provider, they did note that children who went to the dentist for early preventive care visits were more likely to have subsequent dental care, such as caries-related treatment, and greater expenditures.
“This study highlights the need for continued careful evaluation of the evidence basis for clinical recommendations,” says Justin Blackburn, Ph.D., assistant professor in the department of health care organization and policy at UAB and one of the researchers involved in the study. “What we find is that we cannot definitively say whether early preventive dental visits reduce tooth decay with the available data.”
In response to the study, the American Dental Association and American Academy of Pediatric Dentistry notes there are inherent limitations to Medicaid data and little is known about the state of the children’s oral health when they were seen by the dentist for the first time, such as whether they were referred to a dentist because they showed signed of cavities or if they were already experiencing tooth decay.
“A study like this is great for initiating conversation, but it tends to pose more questions than provide answers, and that can be good because that prompts additional research,” says Jane Grover, D.D.S., M.P.H., ADA spokesperson. “Researchers will be inspired to say, ‘What does that higher rate of visits actually mean?’”
“Studies of this nature are important in advancing our knowledge about early childhood cavities and their prevention and treatment, but these findings are not definitive, and further study is critical, in view of other findings supportive of early care and the epidemic nature of early childhood cavities,” says Paul Casamassimo, D.D.S., M.S., director of the AAPD’s Pediatric Oral Health Research & Policy Center.
In addition to this research, a recent study done by researchers at King’s College London and the University of Washington found chronic maternal stress is associated with a higher prevalence of cavities among children. Researchers discovered that dental cavities were more common among children whose mother had two or more biological markers of chronic stress.
“We look for ways to educate parents on aspects of optimizing oral health for their families,” Grover says. “Part of that includes an understanding of some of the basics of dental decay, which foods pose a higher risk, what consumption patterns pose a higher risk. We want parents to be well-versed in the information they need to keep their families healthy.”
Infants and children exposed to secondhand smoke may also be at a greater risk of caries in deciduous teeth. In a 2015 study, researchers in Japan found four-month-old babies that had been exposed to tobacco smoke were two times as likely to have caries than children in a non-smoking home.
The University of Alabama study, titled “Outcomes Associated With Early Preventive Dental Care Among Medicaid-Enrolled Children in Alabama,” was published online in JAMA, the Journal of the American Medical Association.