PROJECT SUMMARY/ABSTRACT
Poor oral health during pregnancy may have long term implications for the oral and overall health of expectant
mothers and their children. For example, children of mothers with high levels of tooth decay have three times
the odds of developing caries before their sixth birthday. Tooth decay is the most common chronic disease of
childhood and particularly acute for non-Hispanic Black and Hispanic children who experience more than twice
the rate of untreated decay compared with non-Hispanic white children. While pregnancy increases a person’s
susceptibility to oral health problems, pregnant people are less likely to visit the dentist (44%) than
reproductive-aged people who are not pregnant (65%). The objective of this application is to use quasi-
experimental methods to estimate the effects of Medicaid pregnancy dental benefits on dental care use among
pregnant people and subsequent outcomes among their children and to evaluate whether these policies have
the potential to promote health equity. Our central hypothesis is that pregnancy dental benefits will increase the
use of all service types among pregnant people and increase preventive care but reduce the need for
restorative treatment among young children by delaying or preventing the onset of dental caries. The central
hypothesis will be tested by pursuing three specific aims: 1) to examine the effects of Medicaid pregnancy
dental benefits on reported dental visits and claims-based measures of the use of preventive and restorative
dental services among pregnant people; 2) to examine the effects of Medicaid pregnancy dental benefits on
later dental care use among children ages 2-11 who were exposed to the policy while in utero, including
reported dental visits, claims-based measures of the use of preventive and restorative dental services, out-of-
pocket spending on dental care, and unmet needs for dental care due to cost; and 3) to evaluate the effects of
Medicaid pregnancy dental benefits by race and ethnicity and by county-level measures of access barriers and
facilitators including dentist supply, federally-qualified community health center supply and investment,
immigration enforcement, and measures of Black-white disparities in income, education, housing, and the labor
market. The research proposed in this application is innovative because it will be among the first to examine
how children’s exposure to Medicaid dental benefits while in utero affects their later dental care utilization, it
will link mothers and their children in a subset of our analyses, and we will apply newly developed methods to
address variation in the timing of state policy changes. The proposed research is significant because pregnant
people and children underutilize recommended dental services, untreated dental caries among children may
interfere with their development, and there are persistent disparities in dental visit rates and oral health by race
and ethnicity. The public health impact of this research will be to provide critical new evidence on whether
pregnancy dental benefits have long-lasting impacts on children who were exposed to the policies while in
utero and to assist policymakers in assessing the full scope of the benefits and costs of these policies.
