Patterns in Pediatric Dental Surgery under General Anesthesia across 7 State Medicaid Programs.

Area of Science:

• Pediatric Dentistry
• Health Services Research
• Public Health

Background:

• Access to dental general anesthesia (DGA) for children is limited, with significant wait times.
• Factors influencing DGA access exist at facility, dental provider, and anesthesia provider levels.
• The impact of these factors on dental surgery utilization remains unclear.

Purpose of the Study:

• To characterize patterns in DGA utilization.
• To explain variations in DGA use by system, provider, population, and individual disease levels.
• To identify factors influencing children's access to dental general anesthesia.

Main Methods:

• Cross-sectional analysis of Medicaid-enrolled children (≤9 years) from 2011-2012 in six states.
• Characterized DGA events by place of service, disease burden, and provider reimbursements.
• Analyzed average total expenditures for DGA services.

Main Results:

• States with similar caries prevalence showed vastly different DGA rates (e.g., Illinois vs. Washington).
• Reimbursement rates and place of service did not consistently correlate with higher DGA rates.
• High surgical extraction rates in Maryland (lowest DGA rate) suggest unmet needs or overtreatment.

Conclusions:

• DGA rate variations are not explained by reimbursement or caries burden alone.
• Provider and facility capacity, alongside social determinants of oral health, are critical factors.
• Understanding these complex factors is essential for improving access to DGA for children with severe caries.