Childhood Dental Coverage and Facts

Written By: Maral Hindoyan

The Affordable Care Act, enacted in California in March of 2010, enabled reform in the health care system allowing further affordable coverage for the most vulnerable populations.  Among those affected include children, low socioeconomic status individuals, pregnant mothers, etc. Prior to the expansion, coverage for basic healthcare needs, doctor visits, hospital care, prescription coverage, prenatal care and delivery, and children’s dental coverage were not an essential health benefit that was available at lower and more affordable rates (1). The expansion of affordable healthcare created a health insurance marketplace that allows individuals to purchase private health insurance coverage at federally subsidized rates, commonly referred to as Covered California. One of the ten essential benefits of Covered California is dental coverage for children, both preventative and treatment. With coverage, a child can receive a comprehensive exam, x-rays, periodic cleaning, fluoride treatment, bite adjustment and teeth straightening exam, oral hygiene intervention, and any emergency cases as children are more prone to accidents (2).

Early exposure to dental care is important for the child’s overall oral health (2). Childhood dental caries remain the leading preventable disease among children 5 to 11 years old in the United States (3). Untreated dental caries can result in pain, early tooth loss, poor school performance, school absence, and problems with eating and speaking (3). Evidence suggests poor oral health can lead to chronic diseases later on in life, including diabetes and coronary heart disease (3).  Today, 25% of low socioeconomic status (SES) children ages 5 to 19 years old have untreated decay on adult permanent teeth (4,5). Low SES children are twice as likely to have untreated decay on permanent teeth when compared to high SES children (4). In the United States, there is a prevalence of 48% of youth with untreated dental decay and in Los Angeles County, 45% of kindergarteners and 65% of 3rd graders have untreated dental decay (5,6).

Healthy oral health care habits begin during pregnancy (7). Mothers who have untreated tooth decay, increase the chances of their child having tooth decay by three-fold (7). Maintaining dental visits during pregnancy for comprehensive check-ups, cleanings, and potential treatment is recommended by the US Surgeon General, American Pediatric Society, and the American Dental Association (8).

Children are advised to visit a dental office as soon as two teeth meet one another, usually under the age of one (9). Creating a dental home and going in for routine dental visits are crucial steps necessary to expose children to a proper dental environment, even if there might not be a  need for dental treatment at that age (9). By two and a half to three years old, a child is expected to have all twenty primary teeth, making visits to the dentist more vital (9). At the age of 5 to 6 years old, the first permanent molar appears (9). Early childhood caries is a preventable disease for children, and maintaining a healthy mouth is vital for the child’s future health (9). Taking steps to ensuring a healthy smile for children includes developing healthy habits. Such as: decreasing sugar consumption, increasing water intake, flossing once a day, brushing twice a day, using fluoridated toothpaste, and visiting the dentist two times a year (10).

Establishing and acquiring dental coverage for your child at a young age can help facilitate the exposure to a dental office and access to a dentist. For more affordable options, a Medicaid-administered program called the Children’s Health Insurance Program, or CHIP for short, expands coverage to child dental care for families meeting the income eligibility requirements (11). To be eligible, a person must be: 1. A resident in the state of California 2. A United States citizen, permanent resident, or legal alien 3. Have a financial situation that is considered low income or very low income (table to income chart) 4. One of the following must apply to you: pregnant, 21 years of age or younger, blind, have a disability or a family member with a disability, or 65 years of age or older. For further information on eligibility, visit the Medi-Cal website.

InsuranceKids.gov is a search engine that helps individuals understand dental coverage options based on their state, for children up to 19 years old.12 The CHIP programs include 1) relief of pain and infection, 2) restoring teeth and 3) maintaining dental health (11).

Many adults purchase supplemental dental insurance policies for their families in order to cover treatment costs that are not covered by their primary insurance (13). Purchasing a supplemental dental insurance policy further extends coverage to their children (13). The Health for California website is a valuable source used to understand supplemental insurance options and depth of coverage (13).

In all, since the passage of the Affordable Care Act, access to childhood dental care is more affordable and available for the greater underserved populations in Los Angeles County. For additional resources and information, visit the sites below.

1.     Medi-Cal- website for Medicaid enrollment and information on eligibility

2.     InsuranceKids.gov- information on dental coverage options

3.     Health for California- supplemental dental insurance

4.     CalWic- WIC facilities help finding dental homes

References:

1. The Affordable Care Act. HealthCare.gov. Accessed January 7, 2023. http://www.insurance.ca.gov/01-consumers/110-health/10-basics/aca.cfm

2. Dental Insurance for Kids | Health for California. Health for California Insurance Center. Accessed January 7, 2023. https://www.healthforcalifornia.com/blog/dental-insurance-for-kids

3. Silk H, Kwok A. Addressing Adolescent Oral Health: A Review. Pediatr Rev. 2017;38(2):61-68. doi:10.1542/pir.2016-0134

4. Disparities in Oral Health | Division of Oral Health | CDC. Published February 5, 2021. Accessed October 16, 2022. https://www.cdc.gov/oralhealth/oral_health_disparities/index.htm

5. Health (DOH) TD of O. CDC - Children - Division of Oral Health. Published May 13, 2022. Accessed October 16, 2022. https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html

6. Cabezas M, Chan L, Chen R, et al. ORAL HEALTH IN LOS ANGELES COUNTY DISEASE BURDEN AND PREVENTION 202. :64.

7. Pregnancy and Oral Health Feature | CDC. Published March 18, 2022. Accessed October 20, 2022. https://www.cdc.gov/oralhealth/publications/features/pregnancy-and-oral-health.html

8. Liu PP, Wen W, Yu KF, Gao X, Wong MCM. Dental Care-Seeking and Information Acquisition During Pregnancy: A Qualitative Study. Int J Environ Res Public Health. 2019;16(14):2621. doi:10.3390/ijerph16142621

9. RAMOS-GOMEZ FJ, CRYSTAL YO, NG MW, CRALL JJ, FEATHERSTONE JDB. Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment. J Calif Dent Assoc. 2010;38(10):746-761.

10. Cavities/tooth decay - Symptoms and causes. Mayo Clinic. Accessed October 14, 2022. https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892

11. Dental Care | Medicaid. Medicaid. Accessed January 7, 2023. https://www.medicaid.gov/medicaid/benefits/dental-care/index.html

12. Getting Covered to Go Back-to-School! | InsureKidsNow.gov. Medicaid and CHIP Coverage. Accessed January 7, 2023. https://www.insurekidsnow.gov/find-coverage-your-family/getting-covered-go-back-school/index.html?utm_medium=Search&utm_source=Gooogle&utm_campaign=BtS2022_National&utm_content=pn-08012022_ChildInsure_V5

13. Covered California Insurance Carriers | Health for CA. Health for California Insurance Center. Accessed January 7, 2023. https://www.healthforcalifornia.com/covered-california/health-insurance-companies