摘要：Objectives. We determined the association between timing of a first dentist office visit before age 5 years and dental disease in kindergarten. Methods. We used North Carolina Medicaid claims (1999–2006) linked to state oral health surveillance data to compare caries experience for kindergarten students (2005–2006) who had a visit before age 60 months (n = 11 394) to derive overall exposure effects from a zero-inflated negative binomial regression model. We repeated the analysis separately for children who had preventive and tertiary visits. Results. Children who had a visit at age 37 to 48 and 49 to 60 months had significantly less disease than children with a visit by age 24 months (incidence rate ratio [IRR] = 0.88; 95% confidence interval [CI] = 0.81, 0.95; IRR = 0.75; 95% CI = 0.69, 0.82, respectively). Disease status did not differ between children who had a tertiary visit by age 24 months and other children. Conclusions. Medicaid-enrolled children in our study followed an urgent care type of utilization, and access to dental care was limited. Children at high risk for dental disease should be given priority for a preventive dental visit before age 3 years. Early childhood caries, or tooth decay in children younger than 6 years, is the most common chronic disease among children. Its prevalence increased to 28% among 2- to 4-year-old children between 1988 to 1994 and 1999 to 2004, and its impact on children is becoming better known. 1,2 Tooth decay can impair young children’s overall health, speech, growth, and school performance; it can also negatively affect families’ quality of life. 2–6 Because of concern about the impact of dental disease on overall health and the stagnant rate of dental care use over the past decade, Healthy People 2020 identified the annual use of dental care for every person aged 2 years and older as 1 of 24 leading health indicators. 7 Dental use was selected from as many as 1200 objectives as a high-priority health issue. Early childhood tooth decay is preventable and largely reversible in its early stages through self-care, use of professional services, and exposure to community interventions such as water fluoridation. 8,9 During dental visits, children can receive an assessment for disease risk, early detection and treatment services, preventive care such as fluoride therapy, and anticipatory guidance. 8,10–12 To ensure exposure to prevention early in life, professional organizations recommend that children have a dental home by 12 months of age. 10,12–14 North Carolina Medicaid, along with Medicaid in most other states, also recommends a first dental visit by age 12 months; however, North Carolina Medicaid does not require a visit until age 3 years because of a limited supply of dentists. Despite evidence that professional preventive dental care leads to good oral health outcomes, no strong evidence indicates the most effective age for the first visit. A previous study found no difference in the severity of disease at age 6 to 7 years between children whose first dental visit occurred before age 2 years and those who were aged 2 to 5 years at their first visit. 15 Another study found that early dentist visits that included prevention were associated with fewer treatments from the time the children were aged zero to 5 years. 16 Three studies found no relationship between early visits and dental costs or treatment use, 17–19 but one found that children with existing disease who received preventive services earlier had fewer subsequent treatments and expenditures. 19 Previous studies on the age of the first dental visit have primarily focused on treatment and cost outcomes, with conflicting results. It is unclear from studies on treatment outcomes whether children with early visits have differences in disease status. Unlike medical claims, dental claims do not include diagnosis codes, so the extent of disease cannot be determined from claims files alone. We combined claims files with public health surveillance files of oral health status to estimate the effect of the timing of the first dental visit on dental disease history and untreated disease in kindergarten students in North Carolina.
