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The relationship between portable school-based oral health prevention services and subsequent oral health treatment.

OBJECTIVES
This study examines whether a portable, school-based, preventive oral health program was associated with reduced use of treatment services over time.


METHODS
We obtained encounter data from Community Health Center, Inc. (CHC) in Connecticut that operates such a program. We followed cohorts of children for 4 years, examining change in ratio of treatment to total services in the fourth year, following receipt of portable preventive care in the prior 3 years. The sample included 3,006 children 4.5 to 15 years old on their first visit during 2005-2015. We used structural equation path models to assess change in the dependent variable, controlling for available demographics and service use patterns. We conducted additional sensitivity analyses to assess robustness of our findings.


RESULTS
We found a reduction in ratio of treatment (particularly restorative) to total services in the fourth year, given receipt of portable preventive care in the third year (direct impact) and receipt of portable preventive care in prior years (indirect impact). Older children and those covered by Medicaid (versus privately insured) had a higher ratio of treatment to total services in the fourth year.


CONCLUSIONS
Our retrospective analysis showed CHC portable dental program may reduce the use of treatment services over time among underserved children. This program is an example of a viable approach that could be emulated elsewhere if regulations allow remote supervision of hygienists and reimbursement levels are adequate.