Delivery of Preventive Oral Health Services by Rurality

A Cross-Sectional Analysis

Published in: The Journal of Rural Health, Volume 35, Issue 1, pages 3–11 (Winter 2019). doi: 10.1111/jrh.12340

Posted on on February 02, 2021

by Caroline Geiger, Ashley M. Kranz, Andrew W. Dick, Erin Lindsey Duffy, Mark J. Sorbero, Bradley D. Stein


Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality.


We used 2012–2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics.


POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64–0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59–0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties.


In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.

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