title: Preventive Services by Medical and Dental Providers and Treatment Outcomes.
abstract: OBJECTIVE
  Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment.
  
  
  METHODS
  We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding.
  
  
  RESULTS
  We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment = $234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr.
  
  
  CONCLUSIONS
  Because of children's increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs.
authors.affiliation: Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA akranz@unc.edu.
authors.forename: A M
authors.initials: AM
authors.lastname: Kranz
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Rozier
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Preisser
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Stearns
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Center for Health Services Research in Primary Care, VA Medical Center, Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Pediatric Density, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
mesh_terms: D002675:Child, Preschool; D003188:Composite Resins / Q000191:economics; D003442:Crowns / Q000191:economics / Q000706:statistics & numerical data; D003723:Dental Amalgam / Q000191:economics; D019140:Dental Care for Children / Q000191:economics / Q000706:statistics & numerical data; D003731:Dental Caries / Q000191:economics / Q000628:therapy; D003764:Dental Materials / Q000191:economics; D003793:Dental Restoration, Permanent / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D011313:Preventive Dentistry / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D011670:Pulpectomy / Q000191:economics / Q000706:statistics & numerical data; D011672:Pulpotomy / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013193:Stainless Steel / Q000191:economics; D014081:Tooth Extraction / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
chemical_list: D003188:Composite Resins; D003764:Dental Materials; D013193:Stainless Steel; D003723:Dental Amalgam
keywords: Medicaid; access to health care; delivery of health care; oral health; pediatrics; preventive dentistry