1. Danesh, David O. DMD, MPH, MS
  2. Peng, Jin MD, PhD, MS
  3. Hammersmith, Kimberly J. DDS, MPH, MS
  4. Gowda, Charitha MD, MPH, MSCE
  5. Maciejewski, Heather BS
  6. Amini, Homa DDS, MS, MPH
  7. Wapner, Andrew W. DO, MPH
  8. Meyer, Beau D. DDS, MPH


Objectives: To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice.


Design: Retrospective claims-based analysis cohort study.


Setting: Children with Medicaid insurance through an Ohio pediatric accountable care organization.


Participants: Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017.


Intervention: FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider.


Main Outcome Measure: Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes.


Results: The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4).


Conclusions: Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.