Health Insurance and Untreated Dental Caries Among Children in the United States: The Mediating Role of Dental Care Utilization

ABSTRACT Objective We evaluate the extent to which dental care utilization mediates the relationship between health insurance type and untreated dental caries among children in the United States. Methods Our study population included children ages 2–18 in the 2017–March 2020 National Health and Nutrition Examination Survey (NHANES) cycle. The exposure was health insurance (private insurance, Medicaid, no insurance), the outcome was untreated dental caries, and the mediator was dental care utilization (dental visit ≤ 1 year). We conducted causal mediation analyses and adjusted for age, race/ethnicity, and family income to poverty ratio. Results are presented on a risk difference scale with 95% confidence intervals (CIs). Results Untreated dental caries prevalence from 2017 to 2020 was 12.8% (95% CI: (9.46%, 16.15%)) among children aged 2–6 and 11.7% (95% CI: (9.86%, 13.48%)) among children ages 7–18. Children covered by Medicaid/CHIP had a 7.7% (95% CI: (7.5%, 8.0%)) excess risk of dental caries compared to privately insured children. Dental care utilization statistically significantly mediated this relationship by 8.3%. By contrast, risk of dental caries among children covered by Medicaid/CHIP was 5.1% (95% CI: (−5.6%, −4.6%)) less than that of uninsured children. Dental care utilization statistically significantly mediated this relationship by 50.9%. Conclusion Dental care utilization remains an important mechanism in reducing untreated dental caries across insurance types, accounting for a substantially larger share of the difference between children covered by Medicaid/CHIP and uninsured children than between those covered by Medicaid/CHIP and private insurance. Additional mechanisms beyond utilization likely contribute to differences in untreated dental caries between children covered by Medicaid/CHIP and private insurance.