Dissertation Title

Exploring oral health disparities for children in the city of Milwaukee.

Dissertation Abstract

This study investigated whether school-based oral health programs as a public policy intervention increased dental sealant applications among children from low-income families and minorities in public schools in inner city Milwaukee. By using a difference-in-differences analysis, we examined pre-post time frames, 2001-2003 and 2008-2009, to determine sealant application usage in public schools in nine inner city Milwaukee zip codes after the intervention of a public policy initiative to expand school-based oral health programs with the expressed intent of increasing placement of dental sealants in children at high risk for dental decay and disease.

Results of a binary logistic regression revealed that at a .05 criterion of significance, the study's difference-in-differences estimator variable was significant at p < .02, indicative that the policy intervention significantly and positively impacted the delivery of sealants to children attending public schools within the zip codes examined by the study. The study also assessed the demographic characteristics of the school children within the study, reporting that children aged 7, 8 and 9 were most likely to receive sealants, and that while Blacks received the largest percentage of sealants within the study (the study revealed that among racial/ethnic lines, Blacks were disproportionately represented among the school-based population), when sealant numbers were adjusted to numbers of sealants per 1,000 person years, the numbers of sealants for the racial/ethnic categories as well as age and numbers of sealants delivered within zip codes were relatively similar.

Efforts to analyze the cost effectiveness of sealants and their predictive value in estimating future cost savings from reduced dental caries and restorative care were largely inconclusive due to the absence and inconsistency of accurate and standardized sealant cost and expenditure data. However, a limited examination of billings for sealants compared against billings for specific restorative procedures reveals that the relative percentage of billings for sealants versus restorative billings increased, suggesting an increased emphasis on sealant placements as a preventive measure and suggesting the possibility of some reduction in dental caries and restorative procedures and costs. Further research is specifically encouraged relative to the financial impact of the delivery of sealants on future savings due to reductions in tooth decay, disease and restorative services.