Preventive oral health in underserved populations: an economic analysis

Our study adds to the understanding of dental caries prevention in underserved populations. Dental caries is the most common disease of childhood but can be easily prevented. It is therefore essential that policy makers use evidence to promote policies that will help reduce the burden of caries in high-risk children. We collected socioeconomic and demographic data through written surveys from parents of children at the Lyford Consolidated Independent School District in Willacy County. We got a 60% response to our survey. The survey data was matched with dental examination data from a teledentistry project. Only 19% of children in our matched sample had any sealant but 43% had at least one dental caries. Of those without sealants, almost half (49%) had caries while of those with sealants only 19% had any caries. We also found that while half (48%) of those from low-income households (ie, annual income <$25,000) had caries, only a third (34%) of those in high-income households had any caries. Our data analysis involved econometric modeling to study the impact of various factors including dental sealants on the occurrence of dental caries. We assumed dental sealant application to be a proxy for past preventive dental care. We used multivariate probit regression to test for endogeneity in our model. The estimation results from univariate probit models showed a strong and robust preventive effect of dental sealants on dental caries. We used Ordinary Least Squares (OLS), logit, probit, and logistic regressions to confirm the results and obtained similar findings. We used our fitted model to simulate the effect of providing sealants to all children in our sample and found that there will be a 52% - 68% decrease in the mean predicted probability of caries in different scenarios. Finally, we used cost estimates from published studies and the annual survey of dental fee by the American Dental Association to calculate cost-benefit of providing sealants through school-based programs. We found school-based sealant programs to be cost-beneficial. Our analysis leads to a recommendation to promote school-based sealant programs in underserved populations.