An ABCD Program to Increase Access to Dental Care for Children Enrolled in Medicaid in a Rural County

This article examines the extent to which caries prevalence and untreated caries vary in children by ethnicity and household income level. Data from the Third National Health and Nutrition Examination Survey, 1988-1994, for 10,332 children 2 to 18 years of age indicate that lower-income children and Mexican-American and African-American children are more likely to have a higher prevalence of caries and more unmet treatment needs than their higher-income and non-Hispanic white counterparts.

The study aimed to investigate caries prevalence in children using a severity grading diagnostic system, and to evaluate the influence of different diagnostic thresholds on the caries data. A group of 513 children, aged 5, 12 and 18 years, were examined clinically, and with available bitewing radiographs, by four calibrated examiners. The inter- and intra-examiner reliability, assessed by a weighted kappa, varied between 0.80 and 0.95. The mean dmft/DMFT values were 3.8, 5.8 and 11.0 for the three age groups respectively, and the corresponding dmfs/DMFS values were 5.4, 9.9 and 22.6. The d/D-component constituted the major part of the dmf/DMF index in all age groups, and enamel lesions accounted for 59%, 89% and 86% of the d/D-component in the three age groups respectively. It is concluded that enamel or initial caries lesions contributed substantially to the total caries prevalence, illustrating the importance of using diagnostic criteria that include all stages of clinical caries if a total picture of the caries situation is needed.

Eighty-one percent of general dentists and 86 percent of pediatric dentists who are members of the local dental society in Spokane County, Washington, participated in a pilot program to provide dental care in private offices to children up to 5 years of age from low-income families served by the Medicaid program. Outreach staff from the local public health agency recruited and enrolled families in the program. University faculty provided special training in the care of young children to the dentists participating in the program. In the program's first year, 37 percent of the enrolled children had made at least one visit to the dentist, in contrast to 12 percent of children who were not enrolled in the program.