title: Effectiveness of preventive dental visits in reducing nonpreventive dental visits and expenditures.
abstract: OBJECTIVE
  Although preventive dental visits are considered important for maintaining pediatric oral health, there is relatively little research showing that they reduce subsequent nonpreventive dental visits or costs. At least 1 study seemed to find that early preventive dental care is associated with more restorative and emergency visits. Previous studies are limited by their inability to account for unmeasurable factors that may lead children to "select" into using both more preventive and nonpreventive dental care. We used econometric techniques that minimize selection bias to assess the effectiveness of preventive dental care in reducing subsequent nonpreventive dental service utilization among children.
  
  
  METHODS
  Using data from Alabama's Children's Health Insurance Program (CHIP), 1998-2010., a cohort study of children's dental service utilization was conducted. Outcomes were 1-year lagged nonpreventive dental care and expenditures, and overall dental and medical expenditures. Children who were continuously enrolled for at least 3 years were included. Separate models were estimated for children aged <8 years (n = 14 972) and those aged ≥8 years (n = 21 833).
  
  
  RESULTS
  More preventive visits were associated with fewer subsequent nonpreventive dental visits and lower nonpreventive dental expenditures for both groups. However, more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures.
  
  
  CONCLUSIONS
  Preventive dental visits can reduce subsequent nonpreventive visits and expenditures for children continuously enrolled in CHIP. However, they may not reduce overall program costs. Effective empirical research in this area must continue to address unobserved confounders and selection issues.
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama, Birmingham, AL, USA.
authors.forename: Bisakha
authors.initials: B
authors.lastname: Sen
authors.forename: Justin
authors.initials: J
authors.lastname: Blackburn
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morrisey
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
authors.forename: David J
authors.initials: DJ
authors.lastname: Becker
authors.forename: Cathy
authors.initials: C
authors.lastname: Caldwell
authors.forename: Nir
authors.initials: N
authors.lastname: Menachemi
mesh_terms: D000407:Alabama; D002648:Child; D002669:Child Welfare / Q000191:economics*; D002675:Child, Preschool; D015331:Cohort Studies; D003729:Dental Care / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011313:Preventive Dentistry / Q000191:economics / Q000379:methods*
keywords: CHIP; children’s health; dental expenditures; preventive dental care