Disparities in Receipt of Preventive Dental Services in Children From Low-Income Families

Abstract

Introduction: Healthy People 2020 includes a goal of increasing use of preventive dental care among children from low-income families. The services used to define preventive care are evidence-based services (i.e., dental sealants and professionally applied topical fluoride) and professional dental cleaning, which lacks evidence of effectiveness in preventing caries. This study examined how increasing preventive dental care use and reducing disparities by race/ethnicity among children from low-income families varied by the services included in case definitions of preventive dental care use.

Methods: Three case definitions of past-year preventive dental care use were considered: (1) the Healthy People 2020 definition; (2) receipt of an evidence-based caries prevention service; and (3) dental cleaning only. Using pooled data from the 2001-2002 and 2013-2014 Medical Expenditure Panel Survey for each definition, this study conducted in 2017 used multivariate logistic regression to estimate changes in preventive dental care use among children from low-income families by race/ethnicity.

Results: Use increased for all racial/ethnic groups for all definitions. Use of preventive dental care (Healthy People 2020 definition), however, was at least two times higher than evidence-based preventive dental use for all racial/ethnic groups in both survey periods. After controlling for insurance status and parental education, the disparity between non-Hispanic black and non-Hispanic white children in use of preventive dental care that was present in 2001-2002 was not detected in 2013-2014 whereas the disparity for evidence-based preventive dental care use persisted.

Conclusions: Case definitions of preventive dental care that include non-evidence-based services may overstate receipt of effective preventive dental care and reductions in certain racial/ethnic disparities.

Figure 1.

(A) Prevalence of having PDV among U.S. children from low-income families aged 2–18 years, MEPS 2001–2014. (B) Prevalence of having EPDV among U.S. children from low-income families aged 2–18 years, MEPS 2001–2014. EPDV, evidence-based preventive dental visit; MEPS, Medical Expenditure Panel Survey; PDV, preventive dental visit.

Figure 2.

Percentage of EPDV over PDV among children aged 2–18 years from low-income families in MEPS 2001–2002 and 2013–2014. EPDV, evidence-based preventive dental visit; MEPS, Medical Expenditure Panel Survey; PDV, preventive dental visit.