153 - Association Between Downstream Sedation and Upstream Prevention

Purpose. ​​The objective of this study is to analyze the relationship between the number of preventive dental care
visits before the age of two and GA incidence between three and six years of age.

Methods. Deidentified insurance claims data were collected for over 3 million children between 2012 and 2017 as
part of the nation-wide IBM Watson Health MarketScan Database. Claims data included both public and private
insurance. This database was used to identify the initial cohort of 2,880,648 children enrolled in Medicaid and
472,986 commercially insured children between the ages of 6 months and 6 years old. The primary predictor for this
secondary analysis is the number of visits for preventive care. The primary outcome for this analysis is the
occurrence of GA. We analyzed the association between the predictor and covariate with any GA at the bivariate
level using the Chi Square test. We conducted two multivariable logistic regressions. The first model had an
outcome of any GA versus no GA and the covariates were insurance type, number of preventive cleanings,
race/ethnicity. The second model had an outcome of two or more instances of GA versus only one.

Results. 37% of the total sample had any GA. At the multivariable level, males had a 5% lower odds of not having
any GA when compared to females (AOR: 0.946; 95% CI: 0.906-0.987). Of those who received any GA, 25.2%
were Black, 11.1% were Latinx, 56.7% were White, and 7.1% had an Other race/ethnicity. Blacks had a 60% higher
odds, Latinx had a 114% greater odds, and those with an Other race had a 23% greater odds of not having any GA
when compared to Whites. Children who had any occurrence of a prophy had a 237% (14.2-fold) higher odds of not
having any GA (OR: 3.369; 95% CI: 3.252-3.491). Those with any fluoride varnish application had 80% lower odds
of not having any GA when compared to those without fluoride varnish. (OR: 1.426; 95% CI: 1.398-1.455). 

Conclusion. Children who had more prophylactic cleanings were significantly less likely to go under GA. Children
who had fluoride varnish application were also significantly less likely to go under GA. Each additional year of age
at first prophylactic visit was associated with a 33% lower odds of two or more occurrences of GA (extreme GA).
Black children have a 48% lower odds of extreme GA when compared to White children. There was no significant
association detected between Latinx and Other races compared to White. Each additional prophylactic visit was
associated with a 14% lower odds of extreme GA. There was no association detected between either birth sex or
fluoride treatments and the extreme GA outcome.