Measuring the quality of dental care among privately insured children in the United States

Objective To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns. Data source Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019. Study design A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality. Data collection/extraction methods Continuously enrolled US dental insurance beneficiaries younger than 21 years of age. Principal findings Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score. Conclusion Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.