Reducing Oral Health Disparities in Children: Assessing the Multilevel Impact of a Standardized Preventive Dental Care System

Investigator: Elizabeth Mertz, PhD
Sponsor: NIH National Institute of Minority Health and Health Disparities

Location(s): United States


Dental caries, and its resulting cavities, is the most common disease of childhood, causing significant costs to individuals and society. This project will evaluate a clinical evidence-based approach to pediatric oral health care on its capacity to reduce socioeconomic oral health disparities in untreated caries and new caries incidence over time. The results will provide the empirical foundation to develop strategies to reduce health disparities through evidence-based dental system redesign in the era of health care reform and accountability.

Our long-term goal is to improve dental care quality through evidence-based prevention and treatment as a key component in the overall strategy to reduce disparities in children's oral health. Universal pediatric dental coverage has been enabled under the Affordable Care Act (ACA), and achieving access for Medicaid children equal to privately insured children is within reach, yet strong income-related oral health disparities remain. Understanding the dental care system's role in creating or mitigating oral health disparities or improving oral health has been limited to simplistic access metrics (e.g., annual dental visit) and procedures billed (e.g., dental treatment) which only allow general comparisons heavily confounded by quality of care and insurance type. We know little about how caries risk status, diagnoses, preventive therapies, and interventions are linked to oral health in specific individuals and in populations over time. This gap in knowledge can now be overcome through our proposed study of a caries prevention program implemented at a dental accountable care organization serving both commercially insured and Medicaid patients. The program is built into a system that includes a standardized model of diagnosis-driven, risk-based, clinical-decision-supported care documented in an electronic health record (EHR). The objective of this study is to assess the impact of this evidence-based care delivery approach on reducing pediatric oral health disparities and improving children's oral health over time. This study will leverage sophisticated dental informatics allowing us to use big data to measure and comparatively examine untreated caries and new caries incidence over time in the context of real-world clinical care. Additionally, using Oregon Medicaid claims data we can assess the delivery system impact; utilizing national cost data we can model cost-effectiveness and sustainability; and using interviews we can identify impactful patient-centered care considerations that can potentially predict the success of the program – all critical information to inform future translation and implementation efforts. The expected outcome will be the empirical foundation of a sustainable, scalable roadmap for the delivery system and benefit design called for by policy makers to achieve health equity and meet the Quadruple Aim in dentistry: better population health, better care experience, lower cost per capita, and an engaged workforce.