Impact of Dental Care Access on Children's Oral Health and Academic Outcomes

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PROJECT SUMMARY/ABSTRACT Poor oral health in childhood is correlated with more school absences and lower academic achievement. There is evidence to suggest that state-level Medicaid policies, including payment rates to dentists, adult dental coverage, and coverage of fluoride varnish (FV) application by non-dentist primary care providers, have meaningful effects on the likelihood that low-income children receive recommended dental services. However, little research has linked specific Medicaid policies that increase dental care access to measures of child oral health, and further, no rigorous, large-scale studies with plausibly causal research designs have examined the connection between these policies and academic performance. There is a critical need for rigorous evidence on the potential for state-level policies to achieve improvements in these outcomes. This proposal will provide novel evidence on the link between dental care access and measures of oral health and academic performance using a natural experiment design that leverages state-level variation in Medicaid payment rates to dentists, adult dental coverage, and FV policies during 1999-2016 and large-scale national datasets that include exam-based and administrative outcome measures. Our study period captures a substantial number of state-level changes while also representing a relatively recent time frame. Our analysis will also assess important subgroup differences by child sex, age group, and race and ethnicity. In Aim 1, we will examine the link between each policy and oral health measures including the parent-reported condition of teeth from the National Survey of Children’s Health (NSCH), exam-based objective measures of untreated caries and the presence of dental sealants from the National Health and Nutrition Examination Survey (NHANES), and administrative records of emergency department visits for oral conditions from the State Emergency Department Databases (SEDD). In Aim 2, we will assess the connection between each policy and academic outcomes including school absences, school contacts with parents, parental concern about learning pre-school skills, and grade retention from the NSCH, Peabody Individual Achievement Test scores and grade retention from the National Longitudinal Survey of Youth – Child and Young Adult Cohort (CNLSY), and school absences from the Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K). This will be the first national study to estimate the plausibly causal link between increased access to dental care and academic performance among low-income children. This research will provide critical, timely, and policy-relevant new evidence on the effects of increased access to dental care and the role for public health insurance policy.