Preventive services by medical and dental providers and treatment outcomes

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 childand 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. © international & american associations for dental research.