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Medicaid-insured and minority children have poor access to dental care and more cavities than other youths

Untreated dental decay afflicts one-fourth of children entering kindergarten in the United States. Low-income and minority children have more dental cavities, but they see the dentist less often than other children. In fact, fewer than one of every five poor children with State Medicaid insurance receives preventive dental services in a given year.

A new study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00032) reveals specific barriers to dental care among poor and minority children. A second study by AHRQ researcher, Richard J. Manski, D.D.S., M.B.A., Ph.D., and colleagues details profound disparities in the use of dental services by poor and minority youths. Both studies are described here.

Mofidi, M., Rozier, R.G., and King, R.S. (2002, January). "Problems with access to dental care for Medicaid-insured children: What caregivers think." American Journal of Public Health 92(1), pp. 53-58.

These researchers examined the comments of a racially and ethnically diverse group of 77 caregivers, who participated in 11 focus groups to discuss problems they had in obtaining dental care for their Medicaid-insured children. Many recounted negative experiences with dentists and dental office staff, who they said often treated them with disdain. Some said that they sometimes were made to wait for hours while non-Medicaid-insured patients who arrived later were seen ahead of their children. Hispanic parents had the further obstacle of language barriers, both on the telephone and in person.

Moreover, the frustrating and time-consuming search for a dentist, arranging an appointment, and finding transportation left caregivers exhausted and discouraged. They reported that very few dentists accepted Medicaid patients, only saw them at certain times, only saw one Medicaid patient out of each family a day, or simply put them on the back burner for months. Most caregivers did not own a car and had to rely on free transportation provided by social services, which was both unreliable and inconvenient. They were often late for appointments or couldn't make them at all.

Sometimes children missed school because of appointment restrictions imposed by the dental system and transportation difficulties. Delayed appointments often left children with prolonged tooth decay and pain or tooth discoloration, which prompted ridicule by other children at school. Even when they successfully made it to a dental appointment, caregivers still had to navigate some formidable barriers in the dental setting, including long waiting times and judgmental, disrespectful, and discriminatory behavior from staff and providers. The researchers conclude that proposed increases in Medicaid reimbursement rates and patient education will not be sufficient to remove the barriers to dental care cited by these caregivers.

Macek, M.D., Edelstein, B.L., and Manski, R.J. (2001). "An analysis of dental visits in U.S. children, by category of service and sociodemographic factors, 1996." Pediatric Dentistry 23(5), pp. 383-389.

These investigators analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) of 23,230 people (6,595 children) representing about 268 million U.S. residents (75 million children). They determined the distribution of diagnostic, preventive, surgical, and other dental visit types received by U.S. children up to age 18. They found substantial disparities in the level of dental services obtained by poor and minority youths, who are most at risk of developing cavities, compared with other children. Overall, 39 percent of children had a diagnostic or preventive visit, 4 percent had a surgical visit, and 16 percent had a visit for a restorative or other service during the year.

For every type of dental service, use was higher among white than black and Hispanic children and among non-poor than poor children, although there were no differences by sex. These findings suggest that State Medicaid health insurance programs for poor children fail to assure comprehensive dental services for eligible children, and that substantial improvements in dental care for minority and poor children will be necessary to meet national health objectives for 2010.

Age-specific associations varied. The highest proportion of children receiving diagnostic, preventive, and surgical services were in the 6-10 year age category, with a low rate of these services for preschoolers and children over age 10. This suggests that professional guidelines calling for early dental care were not widely followed or accepted by the public or dentists. In contrast, use of restorative and other services increased steadily across age categories, reflecting the cumulative and progressive nature of dental caries.

Reprints of this article (AHRQ Publication No. 02-R045) are available from the AHRQ Publications Clearinghouse.

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