Is early preventive dental care provided by primary care physicians or dentists effective in decreasing caries?

In this study, preventive dentistry delivered by dentists was associated with more visits for dental caries compared with no preventive care. (LOE = 3b)

Blackburn J, Morrisey MA, Sen B. Outcomes associated with early preventive dental care among Medicaid-enrolled children in Alabama. JAMA Pediatr 2017;171(4):335-341.  [PMID:28241184]

Cohort (retrospective)

Self-funded or unfunded

Outpatient (any)

The American Dental Association recommends that children have a dental home within 6 months of the first tooth eruption and no later than 12 months of age. These authors evaluated the administrative records of nearly 20,000 children continuously enrolled in the Alabama Medicaid program from birth until approximately 3 years of age who had at least one claim paid by Medicaid. Approximately 25% of the children received early dental care (within the first 2 years of life). The researchers identified other children who did not have early dental care matched for a variety of factors including healthcare use, comorbid conditions, and so forth. The researchers determined whether dental care was provided by dentists or by primary care clinicians (they excluded children who saw both kinds of providers in their first 2 years of life) and compared these with children who had received no preventive care. Approximately 20% of children seen by dentists for preventive dentistry had at least one caries-related visit (0.3 visits per year) compared with approximately 11% of children who received no preventive dentistry (0.15 visits per year). There was no difference between the proportion of children seen by primary care providers and children who received no preventive care who had at least one caries-related visit or in the number of visits per year. Considerably more than 80% of children seen by dentists or primary care clinicians received dental varnishes. This is a vulnerable population and the goal of early preventive dentistry to decrease dental caries was not observed in this database study. One possible conclusion is that this program failed, but other explanations might account for these observations. The children who receive preventive care are "connected" and more likely to receive early treatment while the comparison group may have had no access to a dentist or whose parents have limited experience or desire to obtain dental care. Additionally, in Alabama, fluoridation of drinking water varies greatly. Sounds like we need more robust studies to sort some of this out!