Thesis
The association of age at first dental visit and infant oral health program participation with oral health outcomes and dental utilization among child patients at The University of Iowa, College of Dentistry
University of Iowa
Master of Science (MS), University of Iowa
Autumn 2021
DOI: 10.17077/etd.006345
Abstract
Background: Dental caries is the most common chronic disease among children all around the world, with higher prevalence among underserved groups. Dental caries can cause children to experience pain, abscesses, and difficulty in sleeping and chewing, which in turn can negatively affect children’s general health, growth and development. Missing school days because of adverse consequences of dental caries, such as pain and abscesses, can also impact children’s ability to learn.
According to the American Academy of Pediatric Dentistry and the American Dental Association, children should have their first dental visit within six months after eruption of the first primary tooth or about 12 months of age. The rationale for these recommendations is that early dental visits can help to prevent dental caries in young children; however, there has been relatively little study of whether early dental visits result in long-term reductions in caries and related treatments.
Objectives: The overall purpose of this thesis was to assess the effect of age at the first dental visit on caries experience and children’s utilization of oral health services among children. A secondary objective was to examine the relationships between participation in a WIC-affiliated Infant Oral Health Program (IOHP) and caries experience and dental utilization among children. Finally, among only those who attended the IOHP, the associations of selected child and family characteristics, including age at their first IOHP visit, on the child’s caries experience and utilization of oral health services were examined.
Methods: This study was a retrospective chart review and used data from two sources: 1) electronic dental records of the University of Iowa College of Dentistry, and 2) records of Iowa Infant Oral Health Program (IOHP). Data from individuals participating in the IOHP were matched to the College of Dentistry database using name and date of birth. Participants were included in this study if they were younger than 6 years old at their first visit to the College of Dentistry, had their first visit between `2008 t0 2018`and had at least 2 years of follow-up. Nearly all children with IOHP participation history who met these criteria were included, and eligible Medicaid-enrolled children served as a comparison group. The total final sample was 2,832 participants, including 206 with IOHP participation history and 2,626 Medicaid enrollees without IOHP participation.
Results: Our study results showed the association between having children’s first dental visit at younger age (before two years old) with lower rates of dmfs values and lower rates of treatment appointments after at least two years of follow-up. The results of multivariable analyses for our total sample revealed that children who had their first dental visit prior to age 2 had, on average, a 46.4% lower rate (95% CI 45.3% to 47.5%, p <0.001) of dmfs values, and a 33.6% lower rate (95% CI 31% to 36%, p <0.001) of treatment appointments over time than did those who had their dental visits at an older age.
Having IOHP history had the same impact and was associated with lower rates of dmfs values and lower rates of treatment appointments after at least two years of follow-up. Children with IOHP participation history had, on average, a 7.4% lower rate (95% CI 4.2% to 10.6%, p <0.001) of dmfs/DMFs counts, and a 15.5% lower rate (95% CI 9.6% to 21%, p <0.001) of treatment appointments over time than did those children without IOHP participation history.
The result of this study among only children with IOHP history showed the association between being diagnosed as high caries risk at the first dental visit and the presence of caries at the first dental visit with higher rates of dmfs/DMFs counts over time. Children who were diagnosed as high risk through caries risk assessment had, on average, a 27.5% higher rate (95% CI 11% to 46.4%, p <0.001) of dmfs counts over time than did those who were diagnosed as lower risk. Moreover, children who were high caries at first visit had, on average, a 99.7% higher rate (95% CI 83.2% to 117.8%, p <0.001) of dmfs counts over time than did those who had no caries at the first dental visit in IOHP clinic. The higher level of mothers’ education had the opposite impact and was associated with lower rates of combined dmfs and DMFs counts over time. Children whose mothers had some college degree had, on average, a 12.7% lower rate (95% CI 5.1% to 19.7%, p= 0.001) of dmfs counts over time than did those whose mothers had a lower education level (High school diploma (GED) or less).
Conclusion: This study provided evidence that lower dmfs/DMFs values at the last dental visit and lower rates of dental treatments were significantly associated with having early dental visits before age of 2 years compared with having a first dental visit at an older age. Moreover, this study found positive association of IOHP participation history with the same study outcomes. If future research confirms the results of this study, then these results can provide evidence-based information to strengthen the current recommendation regarding the benefit of early preventive dental visits. Moreover, this study’s findings regarding the positive association of IOHP history with better caries experience and lower dental services utilization for treatment, suggest that preventive dental components such as the Iowa IOHP should be incorporated into more public health programs, such as WIC. Such efforts could provide more opportunity for low-income populations to have better access to preventive dental care leading to less dental disease in this population.
Details
- Title: Subtitle
- The association of age at first dental visit and infant oral health program participation with oral health outcomes and dental utilization among child patients at The University of Iowa, College of Dentistry
- Creators
- Baharak Eshghipour
- Contributors
- John Joseph Warren (Advisor)Karin Weber-Gasparoni (Committee Member)Julie Reynolds (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Dental Public Health
- Date degree season
- Autumn 2021
- DOI
- 10.17077/etd.006345
- Publisher
- University of Iowa
- Number of pages
- ix, 78 pages
- Copyright
- Copyright 2021 Baharak Eshghipour
- Language
- English
- Description bibliographic
- Includes bibliographical references (pages 76-78).
- Public Abstract (ETD)
Dental caries is one of the most common diseases among children; consequences of having dental cavities can negatively affect children’s quality of life, while early intervention can prevent this from happening. Professional guidelines recommend that children should visit a dentist within six months after eruption of the first primary tooth or about 1 year of age.
This study assessed the association of age at the first dental visit with caries experience and the rate of using dental services. Moreover, this study looked at the association of participating in the Iowa Infant Oral Health Program (IOHP) with the same outcomes. The Iowa Infant Oral Health Program, affiliated with the local Special Supplement Food Program for Women, Infant, and Children (WIC) clinic, was established by the University of Iowa Department of Pediatric Dentistry, to provide dental care to serve the high-caries risk infants and toddlers attending the WIC clinic.
This study found positive association between having early dental visit before age of 2 years with lower rates of dental caries experience and lower rates of using dental treatment related services after at least two years of follow-up. Moreover, it showed that having IOHP history had the same impact and was associated with lower rates of dental caries experience and lower rates of treatment appointments over time.
If future study confirms the results of this study, then these results could be used as evidence of the importance of early, preventive dental visits on children’s long-term oral health.
- Academic Unit
- Preventive and Community Dentistry
- Record Identifier
- 9984210527502771
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