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(SDAS) Dental Homes for Medicaid-Enrolled Children with Autism Spectrum Disorders in the Iowa I-Smile Program


  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)
  • Perinatal/Infancy (0-12 months)


The November 2012 Supplement to the journal Pediatrics highlighted the special health care considerations for children with Autism Spectrum Disorders (ASDs) but glaringly failed to address oral health. Tooth decay, a sign of poor oral health, is the most common disease among children with special health care needs, a population that includes children with ASDs. Untreated tooth decay can lead to pain, hospitalization, systemic infections, and in rare cases death, and has consequences such as missed school days, poor grades, underemployment, and systemic health conditions. This gap in knowledge signifies a larger problem that researchers have failed to seriously identify strategies that will prevent oral health problems in children with ASDs. Previous work shows that Medicaid-enrolled children with ASDs encounter significant barriers to dental care. An important contributor to good oral health is adequate access to dental care. Inadequate dental care use results in high levels of unmet dental need and poor oral health. To address this problem, states like Iowa, Washington, North Carolina, Montana, and South Dakota have developed special oral health initiatives to increase use of dental care services by Medicaid enrolled children. One such program, I-Smile, was implemented in Iowa in 2007 to increase dental utilization rates and to ensure that Medicaid-enrolled children have a dental home. The dental home is a place where children can access comprehensive dental care and is modeled on the medical home concept. I-Smile has improved utilization in poor children generally. However, no studies to date have evaluated whether initiatives like I-Smile improve dental utilization rates for Medicaid-enrolled children with ASDs. We have no information on whether children with ASDs are equally as likely as other children in Medicaid to have a dental home. The factors related to having a dental home and the dental outcomes associated with dental homes for children with ASDs have never been studied. These knowledge gaps are critical barriers to the development of strategies to ensure that Medicaid-enrolled children with ASDs have an equal opportunity to good oral health. In this secondary data analysis, we will use data from the Iowa Medicaid Program, the U.S. Census Bureau, and the Iowa Dentist Tracking System to achieve three Specific Aims: (1) determine if there are dental home disparities for newly Medicaid-enrolled children with ASDs in I-Smile; (2) identify the child-level, family-level, and geographic factors associated with having a dental home for Medicaid-enrolled children with ASDs; and (3) assess dental use and costs related to dental homes for Medicaid-enrolled children with ASDs. The PI is a board-certified pediatric dentist with a PhD in dental public health. The interdisciplinary research team includes an outcomes researcher, developmental psychologist, developmentalbehavioral pediatrician, pediatric neurologist, and biostatistician. The data generated from this study will help identify strategies to improve I-Smile. While the study is based on Iowa data, our approach is generalizable to other states (e.g., Washington, North Carolina, Montana, South Dakota) with similar pediatric Medicaid dental initiatives. We address the Combating Autism Act Initiative Activities 1, 2, and 3 (increase awareness, reduce barriers to screening and diagnosis, and support research on evidence based interventions) and Healthy People 2020 Objectives 1 and 2 (reduce dental caries experience and untreated dental decay in children).


Listed is descending order by year published.

Nakao S, Scott JM, Masterson EE, Chi DL. Non-traumatic dental condition-related emergency department visits and associated costs for children and adults with autism spectrum disorders. J Autism Dev Disord. 2015 May;45(5):1396-407.

Chi DL, Masterson EE, Wong J. U.S. Emergency department use for non-traumatic dental conditions for individuals with intellectual and developmental disabilities. Intellect Dev Disabil. 2014;52(3):193-204.

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