Most young sickle cell patients on Medicaid don’t receive dental care
Lack of care is concerning due to the risk of infections, dental complications
Oral infections carry high risks for people with sickle cell disease (SCD), but most young patients who have insurance through Medicaid don’t receive dental care, a study suggests.
Rates of preventive dental care and dental treatment were comparable between young sickle cell patients and young people without the disease, but this may be problematic, given the risks of oral infections and dental complications in SCD, according to Sarah Reeves, PhD, an associate professor of pediatrics and epidemiology at the University of Michigan Medical School and the study’s senior author.
“Our findings show that we need to take steps to make sure kids with this condition get the dental care they need — by helping dentists feel more prepared to treat them and making sure doctors know how important dental health is for these children,” Reeves said in a university press release. The study was published as a research letter titled “Sickle Cell Disease and Dental Care Access Among Medicaid-Enrolled Youths” in JAMA Network Open.
In SCD, mutations in the beta-globin gene lead to a faulty version of hemoglobin, the oxygen-carrying protein in red blood cells, being produced. This causes the cells to change shape and be more prone to getting stuck inside blood vessels, impeding blood flow, and can result in sudden episodes of severe pain and other complications caused by organs and tissues not receiving enough blood.
Another key feature of sickle cell is a vulnerability to infections, including oral infections. These “are especially dangerous for people with sickle cell disease because they can trigger or worsen symptoms and serious complications,” Reeves said. “Preventative dental care helps reduce the risk of pain crises and hospitalizations.”
Medicaid, a government-sponsored health plan for people with low income, covers dental care for children, with recommendations for annual visits. Many dentists don’t accept Medicaid, however.
Risk of dental complications makes lack of care worrying
Reeves’ team examined dental care for young Medicaid recipients with sickle cell and compared it with that of those on Medicaid who didn’t have sickle cell.
Using Michigan Medicaid claims data, the researchers identified 1,096 people, ages 1-20, with SCD. The same data set had more than 1.18 million young people in this age range. They looked for dental claims during 2022 and found that less than half the young people in both groups received dental care (42% of SCD participants, 44% overall). This trend was true for preventive care (38%, 40%) and treatment (15%, 18%).
As a whole, “youths with SCD in Michigan had comparable rates of dental service usage to the general pediatric Medicaid population, which is concerning given their risk for dental complications,” the researchers wrote.
There were slightly larger differences for children aged 6-14. In this group, children with SCD were found to be significantly less likely to receive any dental services than the general population (50% vs. 54%). A similar gap was seen in preventive dental services — 46% vs. 51%. The proportion of children receiving dental treatment was comparable in the two groups.
No significant differences emerged in children, ages 1 to 5, or older teens, ages 15 to 20.
“There are many reasons why dental care rates are low in this group,” Reeves said. These may include a lack of dentists accepting Medicaid, as well as a lack of specific guidelines on how to treat SCD patients. Future research should look at what those barriers are and how we can overcome them to improve care for this vulnerable population.”
Interventions to train dentists and other clinicians about the importance of dental care for sickle cell youths might help address these problems, the researchers said.
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