title: The Effects of Distance to Dentists and Dentist Supply on Children's Use of Dental Care.
abstract: To examine the effects of distance to dentists and dentist supply on dental services use among children with Medicaid coverage in Iowa.
  
  
  
  Iowa Medicaid claims for enrolled children between 2000 and 2009.
  
  
  
  The study sample included 41,554 children (providing 158,942 child-year observations) who were born in Iowa between 2000 and 2006 and enrolled from birth in the Iowa Medicaid program. Children were followed through 2009. We used logistic regression to simultaneously examine the effects of distance (miles to nearest dentist) and county-level dentist supply on a broad range of dental services controlling for key confounders. Additional models only used within-child variation over time to remove unobservable time-invariant confounders.
  
  
  
  Distance was related to lower utilization of comprehensive dental exams (2 percent lower odds per 1 mile increase in distance), an effect that also held in models using within-child variation only. Dentist supply was positively related to comprehensive exams and other preventive services and negatively related to major dental treatments; however, these associations became smaller and insignificant when examining within-child changes except for other preventive services.
  
  
  
  Longer distance to dentists is a barrier for use of comprehensive dental exams, conditional on dentist supply.
authors.affiliation: Department of Health Management and Policy, University of Iowa, Iowa City, IA.|Department of Economics, University of Iowa, Iowa City, IA.|Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA.|Public Policy Center, University of Iowa, Iowa City, IA.|National Bureau of Economic Research, Cambridge, MA.
authors.forename: George L
authors.initials: GL
authors.lastname: Wehby
authors.affiliation: Department of Health Management and Policy, University of Iowa, Iowa City, IA.
authors.forename: Dan M
authors.initials: DM
authors.lastname: Shane
authors.affiliation: Public Policy Center, University of Iowa, Iowa City, IA.
authors.forename: Adweta
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Public Policy Center, University of Iowa, Iowa City, IA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Momany
authors.affiliation: Department of Oral Health Sciences, University of Washington, Seattle, WA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.affiliation: Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA.|Public Policy Center, University of Iowa, Iowa City, IA.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Kuthy
authors.affiliation: Department of Preventive and Community Dentistry, University of Iowa, Iowa City, IA.|Public Policy Center, University of Iowa, Iowa City, IA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Damiano
mesh_terms: D002675:Child, Preschool; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D003815:Dentists / Q000600:supply & distribution*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007484:Iowa; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D014481:United States
keywords: Dental care; Medicaid; dental workforce; dentist supply; oral health; prevention