Children who do not receive routine dental care are also less likely to benefit from school-based cavity prevention programs, according to research published in JAMA Network Open.
“Our study suggests that children who may need these services the most are the ones least likely to receive them,” said Shulamite Huang, an assistant professor of epidemiology and health promotion at NYU College of Dentistry.
The study also found that increasing participation in school-based dental programs—particularly among children at high risk for tooth decay—could generate substantial savings. Researchers estimate that improving enrollment could avert up to $2.4 million annually in emergency department charges in New York.
Each year, children miss more than 34 million hours of school to receive emergency dental care, while hospitals have reported a sharp rise in pediatric dental-related emergency room visits in recent years. School-based programs offering non-invasive treatments such as sealants have been shown to prevent cavities and reduce the need for urgent care. However, participation depends on parental opt-in, raising questions about whether these programs effectively reach children with the greatest need.
New York State has recently committed $10 million to expand access to school-based dental services and improve oral health outcomes among children. Against this backdrop, Huang and colleagues analyzed data from more than 63,000 Medicaid-enrolled children in the Bronx, including over 1,000 participants in school-based prevention programs.
Using Medicaid claims data, the researchers examined prior dental visits and emergency care utilization. The findings revealed that children with an established history of dental care were more likely to participate in school-based programs. In contrast, those with no prior dental visits were 18 percent less likely to enroll. Similarly, children with a history of dental emergencies—who are likely at higher risk for decay—were also less likely to participate.
The researchers further modeled the financial impact of expanding program reach. Their analysis suggests that optimizing recruitment strategies to better engage high-risk children could significantly reduce dental-related emergency department costs across the state.
“This has staggering implications for Medicaid costs,” said Huang. “As New York expands access to school-based dental care, improving recruitment strategies and reorienting outreach to high risk-children could save the state millions and offset some of the costs of expanding care.”
Additional study authors include Ryan Richard Ruff of the University of Pennsylvania School of Dental Medicine, Heather Gold of NYU Grossman School of Medicine, and Scarlett Wang of NYU Wagner School of Public Service. The research was supported by the National Institutes of Health (K25 DE028584-01A1 and K25 DE028584-02S1).
