At the time of the study, Heather Beil was with the School of Nursing, R. Gary Rozier, Sally C. Stearns, and Jessica Y. Lee were with the Department of Health Policy and Management, and John S. Preisser was with the Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Jessica Y. Lee was also with the Department of Pediatric Dentistry, School of Dentistry, University of North Carolina.
Am J Public Health. 2014 Oct;104(10):1979-85. doi: 10.2105/AJPH.2013.301325. Epub 2013 Oct 17.
We determined the association between timing of a first dentist office visit before age 5 years and dental disease in kindergarten.
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.
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.
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.
我们旨在研究儿童在 5 岁前首次看牙医的时间与幼儿园时期牙齿疾病之间的关联。
我们使用北卡罗来纳州医疗补助计划(1999-2006 年)与州口腔健康监测数据进行关联,以比较在 60 个月前(n=11394)接受过就诊的幼儿园学生(2005-2006 年)的龋齿经历,从零膨胀负二项回归模型中得出总体暴露效应。我们分别对接受预防性和三级治疗就诊的儿童重复了该分析。
在 37 至 48 个月和 49 至 60 个月期间就诊的儿童与在 24 个月前就诊的儿童相比,疾病明显较少(发病率比 [IRR]=0.88;95%置信区间 [CI]=0.81,0.95;IRR=0.75;95% CI=0.69,0.82)。在 24 个月前接受三级治疗就诊的儿童与其他儿童之间的疾病状况没有差异。
在我们的研究中,参加医疗补助计划的儿童遵循了紧急护理类型的就诊模式,并且获得牙科护理的机会有限。应优先为高患龋齿风险的儿童在 3 岁之前安排预防性牙科就诊。