More Poor Children Receive Dental Care After Government Programs Hike Payments to Dentists
May 17, 2005

By Nancy Volkers
InteliHealth News Service

INTELIHEALTH - Not surprisingly, children from wealthier families or those with some type of dental insurance are more likely to visit the dentist, but changes in Medicaid and state children's health insurance programs may improve access for children with lower family incomes.

Two studies in the May issue of the Journal of the American Dental Association address this issue. A study of 2,642 Maryland children in either kindergarten or third grade confirmed the conventional wisdom that disadvantaged children receive less dental care. Researchers found that third graders (compared with kindergartners), children not eligible for free or reduced-price lunches (compared with those eligible for these programs), and children with some type of dental insurance (compared with those without) were more likely to have visited the dentist in the past year.

Overall, 74% of the children had visited a dentist in the past year, and 71% had received preventive care in the past year.

The children in the study were less likely to have a regular dentist (83%) than a regular doctor (96%). White and African-American children were more likely than Hispanic children to have a regular dentist.

The second study, conducted in Indiana, showed that dentists treat more poor children when state insurance programs increase the fees paid to dentists when they see poor children.

The study of changes in Indiana's public dental health insurance programs — Medicaid and the State Children's Health Insurance Program (SCHIP) — found that an increase in the fees that dentists receive for treating Medicaid-enrolled children led to increases in dental visits and increases in the number of dentists treating Medicaid-enrolled children.

The researchers compared information on children’s use of dental services in the two years before and after the fee increase, which took place in 1998. Use rates nearly doubled: before the increase, 18% of children on Medicaid visited a dentist; afterward, 32% did.

The number of Indiana dentists seeing Medicaid-enrolled children increased by 42%, from 770 in the year before the change to 1,096 two years after the change.

Although more children visited the dentist after the fee increase, the average number of visits per child per year, and the average number of dental procedures per child per year, did not increase substantially. The cost of the insurance program per child increased from $1.70 to $6.70.

There have been no increases in the amounts of dental fees since 1998. The authors suggest that sustained increases in fees to dentists may improve access to care for Medicaid-enrolled children. Other states, including Alabama, Delaware, Georgia and Michigan, also have seen more dentists accept Medicaid and SCHIP patients after fee increases.

Medicaid requires dental coverage for children (those under 21 years of age), but not adults. The SCHIP programs are administered by each U.S. state, and eligibility varies. These programs are not required to offer dental benefits, but most do.

Tooth decay, or dental caries, is the most common chronic disease in children. More than half of children ages 5 to 9 have at least one cavity or filling. Poor children are twice as likely as children from higher-income families to have tooth decay, and are less likely to be treated for it.