Abstract
Introduction: Early childhood caries burdens children, their families, and the health care system. Utilizing fluoride varnish at medical well-child visits with non-dental primary care providers can be an interprofessional strategy to combat early childhood caries. The COVID-19 pandemic dramatically altered preventive health care delivery and the effects on preventive oral health care delivery have not been previously described.Methods: This analysis used descriptive statistics and non-parametric Wilcoxon Mann-Whitney tests to compare preventive oral health utilization among 1 to 5-year old children in two state Medicaid agencies before and during the pandemic. Fluoride utilization rates at dental visits and medical well-child visits were calculated as number of users per 1,000 enrolled children. Additionally, the proportion of well-child visits that included fluoride application was calculated for each state.Results: During the pandemic, the quarterly fluoride utilization rate significantly decreased at dental visits (pre-pandemic = 153.5 per 1,000 enrolled children; pandemic = 36.1 per 1,000 enrolled children, p < 0.001) and signficantly decreased at medical well-child visits (pre-pandemic = 72.2 per 1,000 enrolled children; pandemic = 32.3 per 1,000 enrolled children, p = 0.03) during the pandemic.Conclusions: The findings highlight the importance of interprofessional collaboration among non-dental primary care providers and dental providers to provide access to preventive oral health services, particularly when access to dentists is limited. Future directions might include rigorous evaluations of co-located medical and dental services or the use of interprofessional telehealth technologies.
Highlights
Childhood caries burdens children, their families, and the health care system
Fluoride utilization rates at dental visits significantly declined in both states
Changes in fluoride utilization rates at well-child visits differed in each state
Summary
Childhood caries burdens children, their families, and the health care system. Utilizing fluoride varnish at medical well-child visits with non-dental primary care providers can be an interprofessional strategy to combat early childhood caries. For more than 25 years, professional guidelines have recommended establishing a dental home by age one [2]. Preventive Oral Health During Pandemic to increase the proportion of early oral health visits was to reimburse physicians for oral health screening, counseling, and prevention (i.e., fluoride varnish) during medical well-child visits [3]. Evidence demonstrated clear increased access to care following implementation of reimbursement for preventive oral health services at well-child visits in physician offices [3, 4]. Children with autism or intellectual and developmental disability had lower preventive care utilization than their peers [8, 9]
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