Preventive Dental Care May in Young Children May Increase Long-Term Health Costs

Receiving preventive dental care before age 2 is associated with tooth decay and high costs.

Dental care for young children has traditionally been thought to improve dental health, and teach good oral hygiene habits early in life. However, findings from a new study indicate that receiving early preventive dental care may not be as beneficial as previously thought.

The American Academy of Pediatrics, American Dental Association, and American Academy of Pediatric Dentistry recommend that children visit a dentist upon the emergence of their first tooth, despite limited evidence about the efficacy of early dental care. Although preventive dental care has increased among children, tooth decay and cavities are becoming more prevalent among those younger than age 5.

In a study published by JAMA Pediatrics, children under age 2 insured by Alabama’s Medicaid program were observed to have an increase in tooth decay-related treatment, more dentist visits, and higher dental costs if they received preventive dental care from a dentist, compared with children who did not receive the care.

The researchers examined Medicaid data from 19,658 children living in Alabama to determine the prevalence of treatment for tooth decay, dental visits, and costs. Of these children, 25.8% received preventive dental care from a dentist before age 2.

The investigators found that 20.6% of children receiving preventive dental care from a dentist underwent treatment for tooth decay, compared with only 11.3% of children who did not receive the care, according to the study. Children who received preventive dental care also saw higher annual dental spending, compared with those who did not receive the services ($168 versus $87).

However, there was a lack of association between preventive dental care delivered by primary care physicians and treatment for tooth decay or increased dental expenditures, according to the study.

"This study highlights the need for continued careful evaluation of the evidence basis for clinical recommendations," said researcher Justin Blackburn, PhD. "What we find is that we cannot definitively say whether early preventive dental visits reduce tooth decay with the available data."

The study authors acknowledge that their research did not measure benefits of preventive dental care, such as improved quality of life, or benefits of education about healthy oral health behaviors, such as teeth brushing, according to the study. The current findings also do not account for water fluoridation.

These findings suggest that organizations that created the preventive dental care guidelines should revisit the topic to better determine if this care is necessary.

"Adding to a limited body of literature on early preventive dental care, we observed little evidence of the benefits of this care, regardless of the provider. In fact, preventive dental care from dentists appears to increase caries-related treatment, which is surprising,” the study authors concluded. “Additional research among other populations and beyond administrative data may be necessary to elucidate the true effects of early preventive dental care.”