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Purpose: Many studies reporting dental utilization under general anesthesia (GA) are dated. The purpose of this study was to provide contemporaneous data about children receiving dental GA by: (1) determining trends in utilization and associated expenditures; and (2) examining the effects of provider distribution., Methods: This time series cross-sectional study of Medicaid-eligible children ages zero to eight years old in North Carolina used aggregate Medicaid claims from State Fiscal Years (SFY) 2011 to 2015 to collect demographic and dental treatment information. Descriptive statistics were stratified by age and year to examine trends over time. Panel analysis techniques were used to explore regional effects of provider distribution on dental GA utilization., Results: For SFY 2011 to 2015, the overall dental utilization rate was 517.1 per 1,000 (total enrolled equals 632,941 children/year), and the dental GA utilization rate was 15.8 per 1,000. Total dental expenditures averaged $113 million per year, and dental GA averaged $16.7 million per year. The dental GA proportion of expenditures increased over time (P<.001). Provider distribution did not affect dental GA utilization rate (P=.178) but did increase the number of children receiving dental GA (P<.001)., Conclusions: Utilization and expenditures associated with dental treatment under general anesthesia continue to increase. While this reflects increased access to care, interventions should be examined to provide preventive care earlier in a child's life.

Monetary incentives are frequently in tension with evidence-based and cost-effective clinical care, thus posing an ethical concern in the practice of dentistry. The purpose of this commentary was to examine the issue of treating children in the context of caries risk assessment and with specific reference to the periodic oral examination, radiographic surveillance, topical fluorides, and the pumice rubber prophylaxis.

Purpose: The purpose of this study was to assess the impact of silver nitrate/fluoride varnish (SN/FV) on care costs., Methods: A retrospective matched cohort study, using Oregon Medicaid claims (January 1, 2012 to December 31, 2014) for patients younger than 21 years old, compared patients treated with SN/FV to matched patients not treated with SN/FV. The number of services and costs were compared using student's t test and generalized estimating equation (GEE) regression models., Results: Patients treated with SN/FV (n equals 4,612) and matched patients treated conventionally (n equals 13,498) averaged 28±7 (SD) months of continuous eligibility based on initial treatment date. The number of first-year services and total services over an average of 28 months were higher for patients treated with SN/FV (10.6 versus 6.7 in year one; 19.3 versus 8.8 overall; P<0.0001). Excluding diagnostic/preventive services, costs were higher in patients treated conventionally than patients treated with SN/FV in the first year. Overall costs were similar ($698 versus $707; P=.52). The average number of services was 58 percent higher (95 percent confidence interval [CI] 1.54 to 1.63) for patients treated with SN/FV, but costs remained similar., Conclusion: Patients treated with silver nitrate/fluoride varnish accrued a greater number of services and higher total costs over approximately 28 months but lower treatment costs than patients treated conventionally.

Purpose: The purpose of this study was to perform a cost-benefit analysis of the age one dental visit for privately insured patients., Methods: A major insurance company provided claims from various states submitted between 2006-2012. Data provided included numbers of procedures and respective costs from the first visit until age six years. Data was organized into five groups based on age, for which the first D0145/D0150 code was submitted [(1) age younger than one year old; (2) age one or older but younger than two years old; (3) age two or older but younger than three years old; (4) age three or older but younger than four years old; and (5) age four or older but younger than five years old]. The ratio of procedures per child and average costs per child were calculated., Results: Claims for 94,574 children were analyzed; only one percent of these children had their first dental visit by age one. The annual cost for children who had their first dental visit by age one was significantly less than for children who waited until an older age., Conclusion: There is an annual cost benefit in establishing a dental home by age one for privately insured patients.

Purpose: To examine the relationship between state health insurance Exchange selection and pediatric dental benefit design, regulation and cost., Methods: Medical and dental plans were analyzed across three types of state health insurance Exchanges: State-based (SB), State-partnered (SP), and Federally-facilitated (FF). Cost-analysis was completed for 10,427 insurance plans, and health policy expert interviews were conducted. One-way ANOVA compared the cost-sharing structure of stand-alone dental plans (SADP). T-test statistics compared differences in average total monthly pediatric premium costs., Results: No causal relationships were identified between Exchange selection and the pediatric dental benefit's design, regulation or cost. Pediatric medical and dental coverage offered through the embedded plan design exhibited comparable average total monthly premium costs to aggregate cost estimates for the separately purchased SADP and traditional medical plan (P=0.11). Plan designs and regulatory policies demonstrated greater correlation between the SP and FF Exchanges, as compared to the SB Exchange., Conclusions: Parameters defining the pediatric dental benefit are complex and vary across states. Each state Exchange was subject to barriers in improving the quality of the pediatric dental benefit due to a lack of defined, standardized policy parameters and further legislative maturation is required.

Purpose: The purpose of this paper was to determine if number and cost of dental treatments in high caries-risk children differs in children with early dental intervention compared to children with later intervention., Methods: Billing data from children age zero to seven years old, whose first dental visit was between January 1, 2004 and December 31, 2004, were collected from 20 corporate treatment centers serving children from lower socioeconomic status backgrounds. Data included age at first visit, dental treatment codes, and associated costs for eight years after the first dental visit. Treatment included restorations, crowns, pulpotomies, and extractions. First visit age was categorized into early starters (younger than four years old) and late starters (four years of age or older). Linear regression with cluster adjustment for clinic determined a difference in costs and dental treatments by early and late starters., Results: Of 42,532 subjects, 17,040 (40 percent) were early starters and 25,492 (60 percent) were late starters. There were 3.58 more dental procedures performed on late starters, over eight years of follow-up, than on early starters (P<.001). Late starters spent $360 more over eight years of follow-up than early starters (P<.001)., Conclusion: In this study, number of procedures performed were fewer and cost of treatment less for children seen earlier versus later.

Purpose: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentist's attitudes toward Healthy Kids Dental and Medicaid in Michigan., Methods: An online survey was sent to practitioners with an e-mail address registered with the Michigan Dental Association (N=4,285)., Results: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with the HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001)., Conclusions: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Purpose: This study's purpose was to compare pediatric dental services provided for Medicaid and military dependent children to determine if differences in dental treatment choices exist based on site and payment method., Methods: Subjects included 120 Medicaid patients at the University of Texas Health Science Center at San Antonio and 120 military dependents at Lackland Air Force Base, Texas. Demographic data and treatment information were abstracted for children younger than 6 years old receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher's exact tests., Results: The Medicaid recipients were younger (40.2 vs 49.8 months, P<.001) and more likely to be Hispanic (78% vs 30%, P<.001). The means of decayed teeth, fillings, and stainless steel crowns did not differ between sites. Medicaid children received more composite fillings (P<.001), fewer amalgam fillings (P<.001), fewer pulp therapies (P<.001), more extractions (P=.01), and fewer sealants (P<.001). Age and gender did not affect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs 8.6, P=.02)., Conclusion: This study found no difference in the number of less conservative, albeit more costly, procedures performed with Medicaid children at a university compared to military dependents at a military base.

Objective: The objective of this study was to examine the relationship between private dentists' attitudes toward Medicaid and Medicaid patients and their extent of Medicaid participation., Methods: A survey was mailed to all Medicaid dentists in Alabama in 2003 (N = 518). Descriptive statistics were calculated, and multiple regression models were tested. The "dentists' extent of participation" was a measure of the percentage of Medicaid patients seen in one month. Independent variables included dentists' personal and practice characteristics; market area characteristics; and dentists' attitudes toward Medicaid and Medicaid patients., Results: A total of 277 (54%) surveys was returned. Non-Caucasian dentists in group practice had a higher mean of extent of Medicaid participation than Caucasian dentists in solo practice. Moreover, compared to privately insured families, dentists had significantly higher mean of extent of Medicaid participation if they perceived Medicaid reimbursement as generous; payments being processed faster; and families as not acceptable to non-Medicaid families in the practice., Conclusions: Dentists' perceptions of Medicaid policies, such as generosity of payment and speed of processing payment, are important to ensure continued provider participation in Medicaid. Strategies to improve dentists' participation in Medicaid must be multifaceted to increase access to dental services for Medicaid children.

The purpose of this paper was to highlight information and issues raised in a keynote address for the American Academy of Pediatric Dentistry's Symposium on Lifetime Oral Health Care for Patients with Special Needs held in November, 2006. Topics include: (1) relevant statistics and definitions; (2) the prevalence and impact of common oral diseases in individuals with special health care needs (ISHCN); (3) an overview of oral health care delivery for ISHCN; (4) key delivery system and policy issues; and (5) a synopsis of major contextual initiatives related to ISHCN. In light of the Academy's primary interest in infants, children, and adolescents--including children with special health care needs--the major focus is on children. Significant oral health and oral health care issues for adults with special needs, however, generally parallel those for children and are of interest to the Academy, particularly as they relate to the transition from pediatric care to adult care, a critical period for extending the level of oral health and health trajectory established during childhood.

The subject of early dental visits as an integral dimension of anticipatory guidance and the related supporting scientific evidence for this concept is a critical and timely issue for the dental profession. The purpose of this paper was to review the scientific evidence and rationale for early dental visits. In theory, early dental visits can prevent disease and reduce costs. During the age 1 dental visit, there is strong emphasis on prevention and parents are given: (1) counseling on infant oral hygiene; (2) home and office-based fluoride therapies; (3) dietary counseling; and (4) information relative to oral habits and dental injury prevention. There is evidence that the early preventive visits can reduce the need for restorative and emergency care, therefore reducing dentally related costs among high-risk children. Preschool Medicaid children who had an early preventive dental visit by age 1 were more likely to use subsequent preventive services and experienced less dentally related costs. These finding have significant policy implications, and more research is needed to examine this effect in a low-risk population.

Purpose: This study examined whether providing insurance through Iowa's State Children's Health Insurance Program, S-SCHIP, had an impact on dental care access for adolescents that was similar to children of other age groups., Methods: Using a pretest, post-test panel study design, an 80-item questionnaire was mailed to the parents of one S-SCHIP enrollee per household at enrollment. A similar instrument was mailed after 1 year. A mixed-mode data collection process was used. Children were compared by age groups (1 to 6, 7 to 12, and 13 to 18). Statistical tests evaluated differences in: (1) demographics between age groups at baseline; (2) outcomes at follow-up; and (3) differences between matched-pair responses prepost., Results: Baseline and follow-up responses were received from 39% of sampled children (N = 1,399). After 1 year, access to and utilization of dental services improved for all age groups. Adolescents, however, were least likely to have had an annual dental visit; 1 in 6 still had unmet dental need or delays. Relative to other health services, dental care was reported to be the highest area of unmet need at both baseline and follow-up, especially for adolescents., Conclusions: Iowa's S-SCHIP program was found to improve dental care access for children of all ages. Nonfinancial barriers, however, still exist for a significant number of adolescents.

Purpose: The purpose of this survey were to assess the dental caries prevalence rate among children enrolled in Ohio's Head Start programs and assess factors relating to their dental care access., Methods: Oral screenings were conducted on 2,555 children, ages 3 through 5 years, at 50 Ohio Head Start centers using probability-proportional-to-size sampling. In addition, parental responses to 6 access-oriented questions on the consent form were analyzed., Results: Overall, 38% of 3- to 5-year-old Head Start children screened had experienced dental caries, and 28% had at least 1 untreated decayed tooth. Of the children with caries experience, 73% had decayed teeth, while the remaining 27% had restorations only. Among children, there were no statistically significant differences associated with race or payment method. With regard to dental care access, 11% of Head Start parents reported they could not get wanted dental care for their children during the previous 12 months, most often due to cost of care/lack of insurance. Nine percent of children had a toothache in the previous 6 months. Although 85% of Head Start children had visited a dentist in the previous 12 months, another 10% had never visited a dentist., Conclusions: The significant prevalence rate of dental caries among Ohio Head Start children is consistent with other states' reports. Although almost 9 of 10 children visited a dentist during the year, three fourths of children with dental caries did not have their care completed by the time they were screened during the second half of the school year. Oral health disparities according to race and payment source were not found among Ohio Head Start children.

Issues related to reimbursement for time and effort expended in providing behavior management services for children often result in confusion and frustration for the parent and practitioner. Multiple medical and dental insurance plans within a state or region frequently lack a common set of definitions that are fundamental in interpreting and applying contract language. Ambiguities and inconsistencies in state and federal programs and regulatory structures, as well as budget concerns, only exacerbate the problem. This paper reviews issues of third-party payment associated with dental care for children requiring behavioral management. An environmental assessment of the health care system identifies individual and societal challenges. A model that identifies stakeholders involved in third-party reimbursement is discussed, noting the incentives faced by each stakeholder and expected behaviors based on those incentives. Strategies for effecting change based on a thorough understanding of each stakeholders' concerns are discussed.

Panel II discussed key issues related to third-party payment for behavior management in pediatric dentistry and responded to a series of questions raised by the Conference Planning Committee. The panel was composed of individuals representing consumers (parents and caretakers), pediatric dentists, other health care providers, and a large dental insurance plan. They were charged with: (1) identifying problems related to third-party coverage and benefits for behavior management; (2) developing recommendations for the American Academy of Pediatric Dentistry; and (3) prioritizing the problems and recommendations.

Purpose: This study sought to identify barriers and facilitators to dental care among families of predominately low socioeconomic status having children with and without HIV., Methods: Twelve focus group sessions with African-American and Hispanic caregivers and 18 individual semistructured interviews with key informant health care providers were held at two sites: a hospital-based program (HBP) and a dental school-based program (DSBP), that provide pediatric dental services. SPSS Textsmart software was used to analyze qualitative data within and across group types and sites., Results: Focus group participants (n = 72, averaging 6 women per group) included: HIV-seropositive biological mothers of HIV-seropositive children (4 groups); HIV-seronegative caregivers of HIV-seropositive children (4 groups); and Medicaid-eligible, HIV-seronegative caregivers of HIV-seronegative children (4 groups). The most commonly expressed barrier to dental care across groups was poor interpersonal communication between dental staff and caregiver/child. HIV-seronegative groups cited health care delivery system factors as barriers to receiving dental care more frequently than HIV-seropositive caregivers who cited shame/anger and family illness as being more important. Common facilitators were positive communication and transportation assistance. Unique facilitators for HIV-seropositive groups were coordination of the dental visits with medical appointments at the HBP. Key informants acknowledged high stress in families having children with HIV/AIDS, cited dental fear among caregivers as a barrier to dental treatment adherence and reported that dental care seemed to be a low priority among many of these families., Conclusions: Facilitators and barriers to care included factors in the family, dental care and health care delivery systems as well as interpersonal communication between the dental providers and the families.

Purpose: The purpose of this study was to report the results of a survey of pediatric dentistry post-doctoral program directors regarding education of post-doctoral students about management of caries in children 3 years-of-age or younger., Methods: Fifty-two pediatric dentistry advanced education program directors were sent questionnaires inquiring about payer sources in their programs, distribution of caries in children 3 years of age or younger within the payer sources, the methods they teach and use to treat the caries, and the effectiveness of treatment and outcome data about the success of their treatment., Results: Twenty-nine programs responded (56%). On average, two-thirds (66%) of the patients in post-doctoral pediatric dentistry programs are Medicaid patients. Program directors are fairly uniform in how they define methods of caries management, and they rate definitive therapy as the most effective method to manage all types of caries. Literature/textbooks were most frequently cited as the major source of scientific evidence to support treatment decisions. Fewer than 20% of program directors have outcome data on the effectiveness of their methods of treatment., Conclusions: Medicaid is the major payer source for patients in post-doctoral programs and definitive therapy is considered by program directors to be the most effective approach to managing caries in this patient population. Program directors rely on the literature and textbooks and few have outcome data.

Purpose: The objective of this study was to survey pediatric dentistry program directors on perceived resource needs and changes over the last 5 years in the characteristics of their patient population and on waiting times for dental treatment with sedation or general anesthesia (GA) for children with complex dental and medical histories in hospital- and dental school-based training programs., Methods: A 47-question survey was sent electronically to all pediatric dentistry program directors in the United States using the University of Washington's Catalyst Tools program. Two reminder messages were sent. After 3 months, the data was downloaded and descriptive statistics were performed using the SPSS for Windows version 8.0., Results: Twenty-eight of 54 program directors responded with 26 usable survey responses (48%). Thirty-one percent reported outpatient clinics located in a dental school, 31% reported that their clinics were in a hospital, and 38% had clinics in both settings. Program directors perceive that the number of new, recall and emergency patients and the number of pre-school aged children and children with special health care needs had increased in their programs in the last 5 years. Payment by Medicaid was the most common insurance for children cared for in these settings. The mean waiting time for scheduling treatment with GA for a child in pain is 28 days; without pain 71 days. The mean waiting time for scheduling treatment with sedation is 36 days. The majority of program directors reported they had an adequate number of faculty and residents (61% and 66%, respectively) even though 52% of the directors were presently actively recruiting faculty., Conclusions: 1. Dental school and hospital-based training programs are an important source for an increasing number of children with complex dental needs; 2. The majority of patients treated in the programs are Medicaid beneficiaries; 3. Average waiting times for complex dental care for children in pain is 28 days with GA; without pain and need for GA 71 days; 4. There was an average 36-day wait for treatment with sedation.

Purpose: Because little has been reported about child dental expenditures, federal data were used to estimate dental care expenditures for U.S. children by age, sex, ethnic/ racial background, family income, parental education and parental employment., Methods: Parentally reported data on dental expenditures and sources of expenditures were extracted from the most recent available federal healthcare expenditures studies, the 1996 federal Medical Expenditure Panel Survey (MEPS). Using the survey's large sample and complex design, these data represent the entire U.S. child population., Results: Nearly 12 billion dollars were expended for children's dental care averaging $375 per child who obtained care. Overall sources of payment were 47% out of pocket, 45% insurance and 8% "other" including primarily Medicaid. Disproportionately litde spending was made on behalf of low-income and minority children despite their higher disease experience. The proportion of spending that was paid out of pocket was high for all groups of children including those eligible for Medicaid even though Medicaid prohibits cost sharing., Conclusions: Dental care for children accounts for approximately one-quarter of U.S. dental spending and is a major component of child health care costs. Income and racial disparities in expenditures favor higher income children despite Medicaid coverage for lower income children. High levels of reported out-of-pocket costs for Medicaid eligible children suggest that Medicaid fails to meet families' needs in obtaining care. Meeting the oral health needs of poor children will require considerably greater expenditures, particularly through improved Medicaid financing and administration.

Purpose: This study was performed to determine factors associated with Louisiana dentists' participation in the Dental Medicaid Program., Methods: Surveys were mailed to all pediatric and general dentists as reported by the Louisiana State Board of Licensing. A second mailing was made to non-respondents., Results: Surveys from 956 of 1,926 dentists (50%) were returned. Of 607 general dentists and 40 pediatric dentists who treated dental Medicaid-enrolled children in the past year, 269 (44%) and 18 (45%), respectively, treated all Medicaid-enrolled children. Newly graduated dentists were more likely to be actively enrolled than their more established counterparts (chi 2 = 10.67; p = 0.01). Medicaid reimbursement levels were viewed as "much less" than private fees by 62%, "less" by 33% and "the same" by 4% of the respondents. Broken appointments were the most prevalent reported problem (80%), followed by low fees (61%), patient non-compliance (59%), unreasonable denial of payments (57%), slow payment (44%), and complicated paperwork (42%). With the exception of the perceived importance of Medicaid reimbursement levels, active and inactive general and pediatric dentists' perceptions of the importance of Medicaid issues were not significantly different. These findings indicated that significantly more Medicaid-active general dentists who allocated 10% of their office visits to Medicaid-eligible children felt that slow payment (p = 0.002) and complicated paperwork (p < 0.001) were more important problems than general dentists who allocated less time to Medicaid-eligible children., Conclusions: Louisiana dentists' sources of dissatisfaction with Medicaid are similar to those of dentists in other states. Some of the issues are programmatic and are within the power of the dental Medicaid director and state legislature to address. Patient-related issues such as frequent broken appointments may be addressed by assigning case managers to Medicaid beneficiaries.

Purpose: As a national objective, 50% of US children are expected to have dental sealants on at least one permanent molar by the age of 14 years. The present study was conducted to estimate the prevalence of dental sealants among Alabama Medicaid children and to evaluate the characteristics of the sealant users and non-users so the potential barriers in meeting the year 2000/2010 sealant objectives can be identified., Methods: Alabama Medicaid 1990-1997 claims for children (N = 3,683,842) were analyzed using basic descriptive statistics, likelihood ratio, Chi-Square and t-tests, and ANOVA. Logistic regression analysis was used in identifying the predictors of dental sealant utilization., Results: Nearly 22 percent of children had at least one sealant claim by 12 to 14 years of age (white = 28.3%; Black = 19.8%; OR = 1.6, 95% CI = 1.4-1.8; female = 23.6%; male = 19.7%; OR = 1.3, 95% CI = 1.1-1.4). 5- to 9-year-olds were more likely to have sealants compared to 11- to 14-year-olds (OR = 4.1, 95% CI = 2.7-6.1). The availability of a Medicaid accepting dentist within the county of residence was a significant predictor (OR = 1.5, 95% CI = 1.1-2.2). Less than 2% of the annual amount claimed for total dental services in Alabama was related to sealants and the providers were reimbursed only for 50% to 70% of the amount claimed for sealant procedures., Conclusions: Racial and gender disparities in obtaining care, non-availability of a Medicaid-participating dentist within the county, and lower payment/claim ratio may make the national sealant objective difficult to achieve in Alabama.

Purpose: The purpose of this investigation was to describe and assess the disparities, if any, in parental perceived cost barriers to oral health care among developmentally disabled children using a national data set., Methods: Data from the 1997 National Health Interview Survey (NHIS) were analyzed using a SUDAAN statistical package., Results: After adjusting for age and sex, parental perception of unmet need was significantly associated with developmentally disabled children 2-17 years in lower socioeconomic groups., Conclusions: Though most children from lower socioeconomic groups are eligible for Medicaid coverage, parents of these children perceive cost barriers to dental care. Children with developmental disabilities face even more perceived barriers to care based on family income.

Objectives: This paper presents an economic model which can be used to assess the potential implications of evidence-based caries prevention in pediatric dental practice., Methods: Assessment of the evidence indicated that most children in the United States were likely to experience dental caries, though the severity of the disease would be minimal in most of them. Based on the evidence, it was concluded that annual recall examination and topical fluoride application would suffice as the norm for caries prevention. A model was developed to estimate the extent and cost of caries prevention in a traditional and an evidence-based pediatric dental practice., Results: The model showed that evidence-based caries prevention resulted in a one-third decline in the number of recall examination visits provided, while the ensuing patient revenues from recall appointments declined by two-thirds in a calendar year., Conclusions: Evidence-based caries prevention will likely result in a significant decline in preventive services revenues and create additional capacity in pediatric dental practices. This economic impact will likely be absorbed by the current undersupply of pediatric dentists and by the reformulation of practice revenue streams.

Purpose: This study compared the expenditure by the state Medicaid program for episodic, nondefinitive care provided through the emergency room (ER) of a children's hospital with the cost to Medicaid of covering that same child with the recommended preventive service calculated on the fee schedule of the state dental Medicaid program., Methods: Records of patients discharged from the ER during 1996-1998 who had a payor source of Medicaid were reviewed and the reimbursement amount determined. This was compared to an estimate of preventive services which would have been reimbursed by Medicaid for each child., Results: During 1996-1998, 97 patients made 102 visits to the ER. Of these, 9 were admitted to the hospital for treatment. The reimbursement amounts for patients admitted to the hospital were ten times greater than the anticipated amount for preventive care. The reimbursement amounts for preventive services was approximately three times more costly than outpatient treatment in the ER for symptoms related to dental caries., Conclusions: Greater expenditures by the state Medicaid program for treatment in the ER as compared to the cost to Medicaid for providing routine, preventive care depended on whether the child was treated as an inpatient or outpatient.

Purpose: This study described the incidence and predisposing, enabling, and need factors of outpatients in a pediatric ER who sought care for nontraumatic preventable dental disease and analyzed treatment rendered by attending physicians and associated hospital charges for treatment., Methods: Chart review of outpatients discharged from the ER of a children's hospital during 1996-97, using ICD-9 diagnostic codes for dental caries, periapical abscess and facial cellulitis yielded the data for this investigation., Results: During 1996-97, 149 patients made 159 ER visits. The most common diagnoses were ICD-9 codes 521.0 for dental caries (48%) and 522.5 for periapical abscess (47%). Medicaid recipients used the ER at an intermediate level between patients with no payor source and those with private insurance. Almost one-half of the accounts changed status during the billing process, with the majority being entered as private pay upon admission, but changing to bad debt or charity after the registration records were processed and collection was attempted. Most patients were treated empirically by the ER physicians according to their presenting signs/symptoms., Conclusion: This study confirmed that parents utilize the ER as their child's primary dental care source.

Purpose: The purpose of this pilot study is to report a cost comparison of general anesthesia (GA) versus oral conscious sedation (CS) for the treatment of pediatric dental patients., Methods: The study sample included 22 children whose parents/guardian selected GA care for their child. Selection criteria limited inclusion to healthy children (ASA I) ages 24-60 m.o. The subjects acted as their own comparison group to an estimation CS model. Models were developed to assess societal costs for treatment under GA and CS. Treatment rendered was equalized using the dental Relative Based Value Units Scale (RBVU)., Results: Ordinary Least Squares Regression analysis techniques showed the association of RBVU to the total societal costs of GA and CS to be significant (P < 0.01) with an adjusted R2 of .64 and .78 respectively. When regression lines were plotted, the intersection represented RBVU level at which societal costs of GA and CS were the same., Conclusion: Under the conditions of this pilot study, it is concluded that CS costs exceed GA costs at a RBVU level of 66.4, which would equate to more than three CS appointments.

Pediatric health policy articulated by the government, health professions, and child advocates is concerned with eliminating health disparities among children and increasing access to essential pediatric health services. National data are widely available on dental health status and associated disparities by income and race, but little data have been reported on dental service utilization by children. Data from the 1996 federal Medical Expenditure Panel Survey were analyzed to determine the percentage of children who obtained a dental visit and the number of visits children experienced by age, sex, ethnic/racial background, family income, and parental education. Overall, 43% of all children ages birth through 18 obtained at least one dental visit in 1996. Among children who see a dentist, the average number of visits during 1996 was 2.7. Low income, low education, and minority status are all associated with both lower odds of having a dental visit and lower number of visits per utilizer. Children under 6 had less than half the dental visit rate of older children and had fewer visits per person among utilizers.

All Medicaid-enrolled children are eligible to receive dental care through the Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT). As part of an evaluation of the effectiveness of the EPSDT program in Iowa, Medicaid enrollment and claims files from fiscal year (FY) 1994 were used to evaluate the utilization of dental services by Medicaid-enrolled children younger than age 6 during FY 1994. During FY 1994, 23% of Medicaid-enrolled children younger than age 6 received at least one dental service while enrolled in the Medicaid program. The total Medicaid-allowed charges for all dental services provided to this population while enrolled in Medicaid during FY 1994 was $1.53 million (the amount Medicaid would pay for the service, prior to calculating any copayments or other insurance charges). Although the EPSDT program in Iowa requires a referral of all Medicaid-enrolled children to a dentist at 1 year of age, fewer than 4% of enrolled children in this age group received any dental services. The percent of enrolled children receiving a dental exam during FY 1994, by age, was as follows: younger than 1 year, 0.2%; age 1, 3%; age 2, 10%; age 3, 27%; age 4, 46%; age 5, 54%. Utilization rates of dental services by Medicaid-enrolled children in Iowa fall far short of federal regulations, which currently require that 80% of enrollees receive EPSDT screenings, referrals, and treatment by age 3.

The purpose of this study was to report trends in dentists' participation in the North Carolina Medicaid program. Medicaid claims files for dental users younger than age 21 were analyzed for seven fiscal years (FY) from 1986 to 1992. Over the study period, the number of pediatric dentists filing any Medicaid claims remained constant but the number of participating general dentists decreased slightly. Intensity of participation, as measured by mean annual reimbursement and mean number of children treated per dentist, increased from FY 89 to 92 for both provider groups. The mean value of services provided for each dental users also increased slightly during the same period. The data revealed over time pediatric dentists treated a larger proportion of the youngest Medicaid dental users.