Study finds Medicaid doesn't help kids' teeth

True or false: If Medicaid were expanded to cover more children, their oral health would improve.

If you answered "true," think again. A new study (November 2009, Journal of the American Dental Association Vol. 140:11, pp. 1403-1412) found that kids who are covered by Medicaid did not have healthier teeth than equally poor kids who don't have any dental insurance.

"Children with Medicaid coverage were more likely to have an annual dental visit and annual physician visit but were no more likely to have good oral health or good general health than were uninsured Medicaid eligible children," wrote Monica A. Fisher, D.D.S., M.S., M.P.H., Ph.D of the University of Kansas and Ana Karina Mascarenhas, B.D.S., M.P.H., Dr.PH of Boston University.

The two researchers analyzed the responses from parents of 2,491 Medicaid-eligible children 2 to 16 years of age who participated in the 1999-2004 National Health and Nutrition Examination Survey.

They determined oral health based on the parents' classification of their kids' teeth as excellent, very good, good, fair or poor. But they determined "caries experience" and "unmet treatment need" based on clinical examinations by dentists.

They found that among the Medicaid-eligible children living at or below 150% of the poverty line in the U.S. from 1999 to 2004 (representing 21.2 million poor children eligible for Medicaid), approximately 40% were uninsured (representing 8.4 million poor children).

Dental visits not enough

Overall, 42% percent of Medicaid-eligible children, representing 8.8 million Medicaid-eligible children in the U.S., had not seen the dentist.

Children who actually had Medicaid coverage were 1.57 times more likely to have seen a dentist in the past year. But those who had seen a dentist were equally likely to have untreated dental caries or poor oral health in general as children who did had not set foot in a dentist's office.

Does this mean that Medicaid is a waste of money, or that seeing a dentist doesn't improve a patient's oral health?

The researchers weren't ready to go that far. They pointed out that just having Medicaid coverage doesn't address all the dental problems of poor families. Often parents have trouble getting kids to the dentist because they lack transportation or can't get time off from jobs. And many dentists don't accept Medicaid. So these parents may have been able to get their kids to a dentist, but that dental visit wasn't enough to address the problems in the kids' mouths.

Frank Catalanotto, D.M.D., a University of Florida College of Dentistry professor who is chair of the Legislative Committee of Oral Health America and a member of the American Dental Education Association Legislative Advisory Committee, said the finding was "unsurprising."

"I think one of the key issues is the fact that older kids had more visits," he said in an e-mail. "The status of dental visits and oral health in younger kids may be more of a reflection that parents did not start seeking care earlier, thus prevention was not started earlier. Plus the overall risk of this population for caries is relatively high, so modest differences in actual care received would have little impact."

Not just oral health

The problem isn't limited to dentistry. The same study found that Medicaid coverage didn't improve kids' overall health or reduce the probability of having untreated asthma.

The researchers noted that more children had seen a dentist in an earlier survey (conducted from 1988 through 1994), a finding they attributed to better participation in Medicaid by dentists. They speculated that this could be due to programs aimed at improving participation, to improved dental benefits within Medicaid, or to increased education and patient support. Or perhaps the change was simply due to improved data collection.

Whatever the reason, they concluded that dentists should participate even more.

"If the 233,104 dentists in the United States in 2008 provided a dental home for one or two additional children with Medicaid coverage each month," they wrote, "the dental profession could address the problem of access to dental care for poor children with Medicaid coverage."