Characteristics of Publicly Insured Children with High Dental Expenses

Background: Dental coverage is provided for all children with Medicaid in Washington State. The goal of this study was to illuminate the characteristics of a sample of Medicaid-enrolled children with high dental expenses. Methods: Dental care utilization data for a 33-month period were obtained from Washington State's Medicaid database. For children, 0 to 6 years, these data were linked with a parent survey addressing oral health behaviors, knowledge, family history of caries, snacking patterns, and access to dental care. Children with dental expenses of $1,000 or more were classified as the “high-expense” group. Risk factors for the high-expense group were evaluated using multiple logistic regression. Results: 345 children had at least one dental procedure including preventive and diagnostic care. Among these, 30 children (9 percent) incurred 64 percent of total dental expenses for the entire group. Parent perception of lack of dental coverage was associated with incurring high dental expenses. Children of Asian or Pacific Islander heritage were at disproportionately high risk compared to White children. Age of child and family history of caries were also associated with increased risk for high expenses. Conclusions: Not all low-income children on Medicaid are at high risk for caries. A combination of factors, including family history of caries and parent's perception of lack of dental insurance coverage, can potentially increase a child's likelihood for high-expense dental treatment. This study highlighted a small group of children with disproportionately high dental expenses. For some, earlier knowledge of coverage may have resulted in more timely access to preventive and diagnostic care, reducing the subsequent need for expensive restorative treatment.