Increasing frequency of pediatric dental visits helps prevent tooth decay

Every child is unique, but children’s healthcare plans tend to follow the same schedules. Nowhere is this more true than in pediatric dentistry, which follows that general rule that says children are seen once every six months, starting at age 1. However, recent research shows this model has many problems, especially with children from low-income families.

A 2010 survey published in Archives of Pediatrics and Adolescent Medicine Journal found that 7.5 million children ages 6 to 12 experienced a toothache within a six-month period; one in seven children reported having pain associated with a toothache (2). These toothaches also affected the child’s performance at school.

Children from low-income families were especially impacted by toothaches, which caused about a third of elementary school absences among children from low-income families, according to a study conducted by the University of Southern California. Students who reported experiencing pain from toothaches were four times more likely to have a grade point average of under 2.8 (3). The most common cause of toothaches is tooth decay, which can be reversed with preventive care (2).

Warren Brill, the president of the American Academy of Pediatric Dentistry (AAPD), says, “We're reaching epidemic proportions of a rapid form of tooth decay especially in younger children, often from disadvantaged backgrounds” (1).

The Affordable Care Act (ACA) has helped increase dental care access for children, but there are still some access-to-care issues within programs that benefit those who are the highest risk for dental caries: underprivileged children. Programs such as Medicaid and Children’s Health Insurance Programs (CHIP) are failing to implement new care methodologies that emphasize the need for preventive care and disease management. According to the Children's Dental Health Project, (CDHP), CHIP often includes service and dollar limits that restrict access to preventative care, and state Medicaid programs utilize outdated schedules, limiting the number of dental visits and preventative services, regardless of professional recommendations (4).

A Center for Medicaid and Medicare Services (CMS) report, “Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents” recommends that state dental periodicity schedules should serve as a “floor,” or the minimum recommended frequency for preventive oral health visits, rather than a “ceiling” (5).

Both CMS and CDHP call for dental periodicity reform, citing the American Academy of Pediatrics Dentistry’s (AAPD) guideline for periodicity. The AAPD guideline supports an increase of preventative care, especially frequent fluoride varnish applications to children who are high risk for dental caries (6). Providing fluoride varnishes frequently can reduce cavities by 30% (4).

Not only does increasing preventive care help decrease the epidemic of tooth decay, it is also highly cost effective. Fluoride varnishes provide a return of 65 cents per dollar spent and follow-up care for children who already had cavities provides a return of 77 to 88 cents per dollar (4). It is also approximately 10 times more expensive to provide inpatient dental care for dental caries than to provide preventive care (5).

Patrice Pascual, CDHP's executive director, said, “Low-income children are most likely to experience tooth decay, but they are least likely to get crucial preventive care. That has to change.”

References
1. http://www.usatoday.com/story/news/nation/2014/03/02/cavities-children-teeth/5561911/
2. Lewis C, Stout J. Toothache in US Children. Arch Pediatr Adolesc Med. 2010;164(11):1059-1063. doi:10.1001/archpediatrics.2010.206. http://archpedi.jamanetwork.com/article.aspx?articleid=383915
3. http://dentistry.usc.edu/2012/08/10/poor-oral-health-can-mean-missed-school-lower-grades/
4. https://s3.amazonaws.com/cdhp/CDHP+Policy+Brief+--+ECC+%28Fall+2014%29+10-22-14.pdf
5. http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/keep-kids-smiling.pdf
6. http://www.aapd.org/media/Policies_Guidelines/G_Periodicity.pdf