Access barriers to dental care for Medicaid patients

Indigent children have higher incidence of dental caries. Recommendations are for preventive dental visits yearly, starting at age one year. In spite of Medicaid coverage of such visits, utilization remains low. Our interest was in understanding the reason for underutilization of dental services. We hypothesized that such underutilization results from inadequate knowledge of available coverage or of the need for early care.

Parents of 77 four-year-olds were surveyed at a university-affiliated pediatric clinic with dental services on site. Parents were asked about their knowledge of Medicaid dental coverage, of the need for early dental care, and frequency of care their child received. Medical records since birth were reviewed.

All parents were aware of the Medicaid eligibility for services; 80% knew dental care was needed by age one year. Only 69% of the children in the survey had received dental care at our clinic; among the remaining 31%, one third reported never receiving dental care, and two thirds stated that they received dental care elsewhere. Among those receiving care in our clinic, 37% had initial visits between 12-23 months old. Annual dental visits for one through four years old were made by 15% of the children, while 25% were seen just once in the four-year interval.

Parents were aware of the availability and necessity of dental care in early childhood, yet few of their children received the recommended prophylactic visits. Medical care providers caring for children play an important role as advocates of early and regular prophylactic dental visits.