This measure assesses the percentage of members under 21 years of age who received a comprehensive or periodic oral evaluation by a dental provider during the measurement year.
Why It Matters?
Oral examinations include physical examination, review of appropriate images and evaluation for risk of tooth decay. Dental caries is the most common chronic disease in children in the United States. From 2015–2016, prevalence of total (untreated and treated) caries-related tooth decay was 46% for children 2–19 years.1 Identifying caries early on is important to reverse the disease process, prevent progression of caries and reduce incidence of future lesions. In 2014, 52% of all children and 60% of children below the federal poverty level did not have a dental visit during the year.
Every year, more than 34 million school hours are lost due to unplanned (emergency) dental care. In 2017, there were 2.1 million dental-related ER visits (both children and adults); Medicaid paid for about 69% of these visits for children.2
The American Academy of Pediatric Dentistry (AAPD) recommends that children receive their first clinical oral examination at the time of their first tooth eruption and no later than their first birthday;3 thereafter, it is recommended that the frequency of examinations be based on the child’s individual needs and susceptibility to disease. Recommendations from the National Institute for Health and Care Excellence (NICE) also support an individualized approach to determining the frequency of dental checks. NICE recommends that that shortest interval between visits for children younger than 18 be no less than 3 months and no greater than 12 months.4
Adverse outcomes associated with untreated dental cavities can be numerous; they include pain, infection, increased ER visits and decreased quality of life.5,6
*This measure has been included in and/or adapted for HEDIS with the permission of the Dental Quality Alliance (DQA) and American Dental Association (ADA). © 2024 DQA on behalf of ADA, all rights reserved.
Historical Results – National Averages
Performance results for this measure are currently unavailable.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- Fleming, E. 2018. Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016. 307, 8.
- CDC. May 13, 2021. Cost-Effectiveness of Oral Diseases Interventions | Power of Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/programs-impact/pop/oral-disease.htm
- AAPD. 2018. Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescent. The Reference Manual of Pediatric Dentistry, 232–42.
- NICE. 2004. “Dental Checks: Intervals Between Oral Health Reviews.” National Institute for Health and Care Excellence, 13.
- Çolak, H., Ç.T. Dülgergil, M. Dalli, M.M. Hamidi. 2013. “Early Childhood Caries Update: A Review of Causes, Diagnoses, and Treatments.” Journal of Natural Science, Biology, and Medicine 4(1), 29–38. https://doi.org/10.4103/0976-9668.107257
- USPSTF. December 7, 2021. Final Recommendation: Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions | United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1