Dental caries is a chronic condition and the most common preventable dental disease affecting children's oral health-related quality of life and well-being. Adequate access to preventive dental procedures remains a challenge for Medicaid-enrolled children. Placement of dental sealants is an evidence-based preventive procedure where a thin plastic coating is bonded into the deep grooves, pits and fissure surfaces of premolar and molar teeth to prevent dental caries (tooth decay). Despite documented evidence of the efficacy, cost-effectiveness and benefits of dental sealant placement, they still remain underutilized. In 2006, the Wisconsin Medicaid program changed its policy to allow dental hygienists in school based settings, to become Medicaid certified providers for dental sealant placement. It is unclear whether this policy change has resulted in an appreciable increase in access and utilization of dental sealants as well as reduced restorative care on first molars for Medicaid- enrolled children in Wisconsin. The goal of this project is to assess whether this policy change in a public health program and system has influenced access, oral health disparities and rates of dental sealant utilization in children considered to be at high risk for dental caries. Ths study will use Medicaid claims data for 2004 to 2013 from the Electronic Data Systems of Medicaid Evaluation and Decision Support (MEDS) database for the state of Wisconsin. Using the Wisconsin Medicaid Claims data we will: 1) assess the overall utilization rates of dental sealant placement among Medicaid- enrolled children pre- and post-policy period; 2) examine the association of patients' socio- demographics, provider characteristics, designation of Dental Health Professional Area (DHPSA) and county level characteristics using Urban Influence Codes on the utilization of dental sealants; and 3) test the association between sealants placed on first molars and restorative treatment for first molars over time. Descriptive statistics and multivariate regression models will be used to estimate the effect of the policy change on the rate at which Medicaid-eligible children receive dental sealants and restorative treatment on first molars. We will control for all available covariates including child's county of residence, age and year. The study will document relevant variables associated with the policy change and the effect on public health service systems and the benefit of collaborative practice of health professionals aimed at eliminating health disparities. This secondary data analysis project is innovative, addresses oral health care disparities and provides documentation that is supportive of community-grounded efforts aimed at improving oral health. Findings from this project may influence future expansion of the policy to other states yet to adopt it, increase awareness about the benefits of sealants as a preventive measure and promote public health program development.

Public Health Relevance

This project will provide documentation regarding the influence of policy change as a driving force for improving access to care, reducing oral health disparities and increasing the utilization of preventive dental services. In addition, it provides information that could have an impact on transforming health improvement efforts through capacity building in public health programs and systems.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Small Research Grants (R03)
Project #
5R03DE024494-02
Application #
8925851
Study Section
Special Emphasis Panel (ZDE1)
Program Officer
Fischer, Dena
Project Start
2014-09-15
Project End
2017-08-31
Budget Start
2015-09-01
Budget End
2017-08-31
Support Year
2
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Marquette University
Department
Dentistry
Type
Schools of Dentistry/Oral Hygn
DUNS #
046929621
City
Milwaukee
State
WI
Country
United States
Zip Code
53201
Rota, K; Spanbauer, C; Szabo, A et al. (2018) Oral Health Practices, Beliefs and Dental Service Utilization of Albanian Immigrants in Milwaukee, Wisconsin: A Pilot Study. J Immigr Minor Health :
Okunseri, Christopher; Okunseri, Elaye; Garcia, Raul I et al. (2018) Impact of Wisconsin Medicaid Policy Change on Dental Sealant Utilization. Health Serv Res 53:312-325
Shenkin, Jonathan D; Warren, John; Spanbauer, Charles et al. (2018) Hospital emergency department visits by ambulance for nontraumatic tooth pain in the USA. Clin Cosmet Investig Dent 10:159-163
Okunseri, Christopher; Zheng, Cheng; Steinmetz, Cory Neil et al. (2018) Trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States. J Public Health Dent 78:109-117
Steinmetz, C N; Zheng, C; Okunseri, E et al. (2017) Opioid Analgesic Prescribing Practices of Dental Professionals in the United States. JDR Clin Trans Res 2:241-248
Okunseri, Christopher; Vanevenhoven, Rabeea; Chelius, Thomas et al. (2016) Travel distances by Wisconsin Medicaid enrollees who visit emergency departments for dental care. J Public Health Dent 76:213-9
Okunseri, Christopher; Dionne, Raymond A; Gordon, Sharon M et al. (2015) Prescription of opioid analgesics for nontraumatic dental conditions in emergency departments. Drug Alcohol Depend 156:261-266