Check-Up on Oral HealthAge One Dental Visits

Michigan County Profile

2017

2 Michigan Oral Health Coalition | Age One Dental Visits www.mohc.org

OVERVIEW Tooth decay is the most prevalent chronic childhood disease in the United States. Each year in the United States, tens of millions of children, disproportionately low-income, go without seeing a dentist. Although tooth decay is largely preventable, it remains largely untreated in young children, especially those under three years of age.1

The American Association of Public Health Dentistry, American Academy of Pediatric Dentistry, American Dental Association, American Academy of Pediatrics, and American Public Health Association recommend that infants receive an oral evaluation within six months of the eruption of the first primary tooth, but no later than 12 months of age.1

FACTORS CONTRIBUTING TO LOW ACCESSThis lack of access to dental care for Michigan’s youngest citizens is a complex problem fueled by a number of factors:

• An uneven distribution of dentists statewide with 59 Michigan counties designated as a Dental Health Professional Shortage Area.2

• In 2012, only 48% of Michigan Medicaid-enrolled children under age 21 received dental care. The relatively small number of dentists who participate in Medicaid means that many low-income people are not receiving dental care.3

• In 2012, 51.9% of Michigan children ages 1-5 yrs. did not receive a preventive dental visit during the previous year.4

• Healthy Kids Dental is recognized for improving access to care for Medicaid-enrolled children by improving provider reimbursement rates. The program is a public-private partnership between the Michigan Department of Health and Human Services and Delta Dental of Michigan.4

• According to a Child Health and Research Unit at the University of Michigan study, as many as three out of four general dentists said they were aware of the American Academy of Pediatric Dentistry’s call for routine dental care to start by age one. But only one third of them said they recommended their own patients start care then. Why? The report noted that many dentists aren’t comfortable with providing routine and problem-oriented care for young children.5

M I C H I G A N O R A L H E A LT H COA L I T I O NMichigan County ProfileAGE ONE DENTAL VISITS

Percent of Michigan Medicaid beneficiaries, under age two, with at least one dental visit in 2015

MEDICAID BENEFICIARIES BELOW AGE TWOIn 2015, 6.3% of Michigan Medicaid beneficiaries below the age of two had at least one dental visit. Charlevoix (39.6%), Ontonagon (38.2%) and Otsego (37.6%) counties had the highest rate of dental visits and Barry (2.2%), Benzie (2.5%) and Missaukee (2.5%) counties had the lowest. On average each Michigan Medicaid beneficiary under age two had 0.08 dental visits.

MEDICAID MEMBERSMedicaid members were included in the analysis if their age was less than 2 years. Age and county for each member are determined as of the end of each calendar year. A dental visit was defined as a visit record with a procedure code beginning with D.

2.2% - 6.3%6.4% - 39.6%Suppressed Rate*

Legend

*State rate is 6.3% * Rates were suppressed if there were less than 5 beneficiaries with a dental visit in county

www.mohc.org Michigan Oral Health Coalition | Age One Dental Visits 3

M I C H I G A N O R A L H E A LT H COA L I T I O NMichigan County ProfileAGE ONE DENTAL VISITS

County

Alcona 8.5Alger 10.7Allegan 5.1Alpena 3.2Antrim 37.3Arenac 25.8Baraga 22.1Barry 2.2Bay 6.4Benzie 2.5Berrien 5.4Branch 7.3Calhoun 14.4Cass 6.1Charlevoix 39.6Cheboygan 8.3Chippewa 8.6Clare 15.3Clinton 9.8Crawford 6.8Delta 4.4Dickinson 24.4Eaton 5.0Emmet 34.1Genesee 12.3Gladwin 9.3Gogebic 28.0Grand Traverse 7.1

County

Gratiot 12.0Hillsdale 7.7Houghton 20.3Huron 10.4Ingham 6.2Ionia 6.7Iosco 15.7Iron 25.5Isabella 13.3Jackson 16.0Kalamazoo 4.3Kalkaska 10.0Kent 4.5Keweenaw ~Lake 13.8Lapeer 3.2Leelanau 3.1Lenawee 9.3Livingston 5.0Luce 7.8Mackinac ~Macomb 3.1Manistee 3.5Marquette 8.6Mason 11.2Mecosta 9.8Menominee 4.3Midland 6.7

County

Missaukee 2.5Monroe 3.2Montcalm 10.7Montmorency 6.5Muskegon 7.7Newaygo 3.6Oakland 2.8Oceana 11.6Ogemaw 19.1Ontonagon 38.2Osceola 10.5Oscoda 3.9Otsego 37.6Ottawa 3.4Presque Isle 4.6Roscommon 14.0Saginaw 3.1Sanilac 7.7Schoolcraft ~Shiawassee 7.7St. Clair 17.1St. Joseph 4.0Tuscola 6.9Van Buren 8.6Washtenaw 4.2Wayne 3.8Wexford 3.8State of Michigan 6.3

AGE ONE DENTAL EXPERIENCEThe following table lists the 2015 percentages of Michigan Medicaid beneficiaries, under age two, with at least one dental visit in the calendar year.

2015Percent

2015Percent

2015Percent

~Rates were suppressed if there were less than 5 beneficiaries with a dental visit in a county.

4 Michigan Oral Health Coalition | Age One Dental Visits www.mohc.org

The MichiganOral Health Program

Increasing Access to Prevention

Now that’s something to S LEabout!

www.mohc.org

M I C H I G A N O R A L H E A LT H COA L I T I O NMichigan County ProfileAGE ONE DENTAL VISITS

AGE ONE DENTAL EXAM ANTICIPATORY GUIDELINES The Michigan Perinatal Oral Health Program has created Michigan Perinatal Oral Health Guidelines which developed evidence based perinatal oral health guiding principles that integrate oral health into the health home for women and infants. Their Pregnancy Oral Health Screenings: A Guide for Perinatal Care Professionals states that during the last post-partum visit, professionals should stress the importance of the first dental visit for infants at the eruption of the first tooth or at age one.6

The American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend the first dental visit includes the following components:

• Oral health risk assessment • Individualized oral care prevention plan based on

caries-risk assessment • Emergency plan for dental trauma management • Anticipatory guidance for families and other

caregivers related to the child’s growth and development issues

• Oral health counseling regarding oral hygiene and lifestyle modifications

• Nutrition and dietary counseling • Comprehensive oral health care in accordance with

recommended periodicity schedules for pediatric oral health

• Referral to dental specialists for emergency or specialized oral health care, as needed

The American Academy of Pediatric Dentistry (AAPD) advocates interaction with early intervention programs, schools, early childhood education and child care programs, members of the medical and dental communities, and other public and private community agencies to ensure awareness of age-specific oral health issues.7

Children who have their first preventive dental visits early in life are more likely to have subsequent preventive visits and less restorative or emergency visits. Consequently, these children incur fewer dental related costs than children who begin dental care at an older age.1

REFERENCES1. ASTDD Association of State and Territorial Dental Directors

(2012). First Dental Visit by Age One Policy Brief.

2. Health Resources and Services Data Warehouse (2016). Michigan Dental Health Provider Shortage Areas.

3. Centers for Medicaid & Medicare Services (2013). CMS Oral Health Strategy Statistics.

4. National Survey of Children’s Health. NSCH 2011/12. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website. Retrieved 11/02/15 from

www.childhealthdata.org.

5. University of Michigan’s Child Health Evaluation and Research Unit (2012). Oral Health Care for Young Children 0-5 Years: From Research to Recommendations.

6. Michigan Department of Health and Human Services (2014). Michigan Perinatal Oral Health Guidelines.

7. American Academy of Pediatric Dentistry, Policy on the Dental Home (2015).

Acknowledgments

Support for this publication was provided by Michigan Oral Health Coalition, through the

Oral Health 2020 Initiative of the DentaQuest Foundation.

Michigan Oral Health Coalition n 106 W. Allegan Street n Suite 310 n Lansing, MI n 517.827.0466 n www.mohc.org