Children’s Oral Health Disparities Persist Despite Equal Dental Care Access
NEW YORK, NY (December 14, 2016) Oral health of children who receive dental care through Medicaid lags behind their privately insured peers, even though the children receive the same amount of dental care, according to a study from the Columbia
NEW YORK, NY (December 14, 2016) Oral health of children who
receive dental care through Medicaid lags behind their privately insured peers,
even though the children receive the same amount of dental care, according to a
study from the Columbia University College of Dental Medicine.
The study was released in Health Affairs’ December issue,
and was discussed by Jaffer A Shariff, DDS, MPH, at a Washington, D.C., health
policy briefing on December 7.
“If poor and low-income children now enjoy equal access to dental
care but do not have equal oral health, then the remedy should focus more
tightly on the day-to-day factors that put them at higher risk for dental
problems,” said lead author Burton L. Edelstein, DDS, MPH, chair of the Section
of Population Oral Health, professor of dental medicine at the College of
Dental Medicine (CDM), and professor of health policy and management at
Columbia’s Mailman School of Public Health. “Low-income families often face
income, housing, employment, and food insecurities that constrain their ability
to engage in healthy eating and oral hygiene practices,” he noted.
The study considered data from the 2011-2012 National Survey of
Children’s Health, which included parent reports of oral health and use of
dental care for 79,815 children and adolescents (age 1 to 17 years) of all
social strata. No differences were found between Medicaid-insured and
commercially-insured children in the odds of their having a dental visit,
preventive or otherwise. However, parents of children enrolled in Medicaid were
25 percent more likely to report that their child did not have an “excellent or
very good” dental condition and were 21 percent more likely to report that
their child had a dental problem within the last year than were parents of
commercially insured children.
“Because we found that low-income kids are seeing dentists at
similar rates as privately insured children, we believe that other issues may
negatively impact low income children’s oral health. Addressing this would
require attention from those currently outside the dental profession, such as
social workers, health educators, nutritionists, and community health workers,”
said Jaffer A. Shariff, DDS, MPH, a research associate in the Section of
Population Oral Health, a periodontal resident at CDM, and co-author of the
study. “We need to develop an oral health promotion system that complements
traditional dental care.”
Medicaid’s Equal Access Provision mandates that Medicaid
beneficiaries have access to equivalent health services as the general
population. While the study confirms that the mandate is being followed, it
also shows that, “equal access to dental care does not ensure that low-income
children obtain and maintain oral health at the same levels as other children,”
Dr. Edelstein said.
Dentists need to “rethink the nature of oral health care by seeing
it as part of a child’s total health care and by treating tooth decay as the
chronic disease that it is. We can’t segregate oral health from overall
health,” Dr. Edelstein cautioned. “Evolving health systems that bring teams of
providers together to promote healthy behaviors can address common risk factors
that benefit a child’s overall and oral health. But if you segregate dentistry,
especially for Medicaid kids, then you lose that opportunity.”
The authors declare no conflict of interest.
