Relationship Between Medical Well Baby Visits and First Dental Examinations for Young Children in Medicaid

Donald L. Chi, DDS, PhD; Elizabeth T. Momany, PhD; Michael P. Jones, PhD; Raymond A. Kuthy, DDS, MPH; Natoshia M. Askelson, PhD, MPH; George L. Wehby, PhD; Peter C. Damiano, DDS, MPH


Am J Public Health. 2013;103(2):347-354. 

In This Article

Abstract and Introduction


Objectives. We examined the relationship between preventive well baby visits (WBVs) and the timing of first dental examinations for young Medicaid-enrolled children.

Methods. The study focused on children born in 2000 and enrolled continuously in the Iowa Medicaid Program from birth to age 41 months (n = 6322). The main predictor variables were number and timing of WBVs. The outcome variable was timing of first dental examination. We used survival analysis to evaluate these relationships.

Results. Children with more WBVs between ages 1 and 2 years and ages 2 and 3 years were 2.96 and 1.25 times as likely, respectively, to have earlier first dental examinations as children with fewer WBVs. The number of WBVs before age 1 year and the timing of the WBVs were not significantly related to the outcome.

Conclusions. The number of WBVs from ages 1 to 3 years was significantly related to earlier first dental examinations, whereas the number of WBVs before age 1 year and the timing of WBVs were not. Future interventions and policies should actively promote first dental examinations by age 12 months at WBVs that take place during the first year of life.


The 2011 Institute of Medicine report Improving Access to Oral Health Care for Vulnerableand Underserved Populations highlighted the persistent disparities in dental care access that affect young children.[1] Fewer than 5% of children have a dental examination by age 12 months as recommended by the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.[2–5] A cornerstone in prevention, dental examinations provide dentists the opportunity to deliver risk-based anticipatory guidance to caregivers, allow for less invasive restorative interventions when disease is already present, and are a source of preventive care provided throughout childhood.[6,7]

Dental examinations are part of a comprehensive strategy to prevent early childhood caries, a type of tooth decay that affects children aged younger than 6 years.[8] Early childhood caries is the most common pediatric disease in the United States and is a public health problem that disproportionately affects low-income children.[9–11]A 70% increase occurred in the prevalence of untreated early childhood caries among low-income children aged 2 to 5 years between 1988 to 1994 and 1999 to 2004.[12] Thus, it is a growing problem. Untreated early childhood caries can lead to pain, infection, hospitalization, and in rare cases death[13–15] and is associated with subsequent tooth decay in the permanent teeth, poor school attendance, and low quality of life—consequences that have deleterious effects throughout the life course.[16–18]

From a public health perspective, earlier first dental examinations are likely to help prevent early childhood caries among low-income children enrolled in state Medicaid programs.[19] One study reported that earlier first dental examinations for Medicaid-enrolled children reduce the need for invasive restorative treatments and are cost effective.[2] The barriers to early first dental examinations include dentists' unwillingness to treat young children, limited caregiver knowledge of when to take their child to a dentist, medical provider uncertainty of when to refer young children, and low Medicaid reimbursement.[20–22]

Although few children have a first dental examination by age 12 months, most have multiple well baby visits (WBVs) by this age.[23] Previous studies have reported associations between preventive medical and dental care use as well as between preventive medical care use and the timing of first dental visits for Medicaid-enrolled children aged 3 to 8 years.[24–26] However, no study has focused on the relationship between WBVs and first dental examinations for young Medicaid-enrolled children younger than 3 years, with an emphasis on how the frequency and timing of WBVs are related to the timing of first dental examinations.

In this study, we adapted a sociocultural oral health disparities model presented by Patrick et al.[27] to test 3 hypotheses: (1) young children with more WBVs are more likely to have earlier first dental examinations than those with fewer WBVs, (2) young children with earlier first WBVs are more likely to have earlier first dental examinations, and (3) other social and behavioral factors are associated with earlier first dental examinations. We focused on WBVs because of the conceptual link between medical and dental care use.[24–26] These first 2 hypotheses are based on the premise that WBVs are proxies for healthrelated behaviors and beliefs influenced by the motivations, values, and personal preferences for earlier first dental examinations by caregivers.[27] The third hypothesis is based on the premise that factors at the system, community, and family level make up the milieu in which decisions are made by caregivers to seek dental care for their child.[27] The information gleaned from this study could help identify specific points in the WBV periodicity schedule at which future population-based interventions aimed at getting infants to the dentist earlier for their first dental examination could be implemented.