Reducing early childhood caries in a Medicaid population

A systems model analysis



      Despite early childhood caries (ECC) being largely preventable, its repair accounts for a disproportionate share of Medicaid expenditures. In this study, the authors model disease reductions and cost savings from ECC management alternatives.


      The authors apply system dynamics modeling to the New York State Medicaid population of young children to compare potential outcomes of 9 preventive interventions (water fluoridation, fluoride varnish, fluoride toothpaste, medical screening and fluoride varnish application, bacterial transmission reduction, motivational interviewing, dental prevention visits, secondary prevention, and combinations) and the effect of defluoridating New York City.


      Model simulations help project 10-year disease reductions and net savings from water fluoridation, motivational interviewing, and fluoride toothpaste. Interventions requiring health professionals cost more than they save. Interventions that target children at high risk, begin early, and combine multiple strategies hold greatest potential. Defluoridating New York City would increase disease and costs dramatically.


      The variety of population-level and individual-level interventions available to control ECC differ substantially in their capacity to improve children’s oral health and reduce state Medicaid expenditures.

      Practical Implications

      Using Medicaid and health department dollars to deliver ECC preventive and management interventions holds strong promise to improve children’s oral health while reducing state dental expenditures in Medicaid.

      Key Words

      Abbreviation Key:

      CWF (Community water fluoridation), ECC (Early childhood caries), MI (Motivational interviewing), NHANES (National Health and Nutrition Examination Survey), NYC (New York City), NYS (New York State)
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      Dr. Edelstein is a professor of dental medicine and health policy & management, Columbia University Medical Center, New York, NY, and a senior fellow in public policy, Children's Dental Health Project, Washington, DC.


      Dr. Hirsch is a proprietor, Learning Environments, Wayland, MA.


      Ms. Frosh was a program director, Children's Dental Health Project, Washington, DC, when this article was written. She now is an executive director, Silver Spring Village, Silver Spring, MD.


      Dr. Kumar is a director, Bureau of Dental Health, New York State Department of Health, Albany, NY.