{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:49:10Z","timestamp":1791510550110,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Public Health Dent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We evaluate the extent to which dental care utilization mediates the relationship between health insurance type and untreated dental caries among children in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our study population included children ages 2\u201318 in the 2017\u2013March 2020 National Health and Nutrition Examination Survey (NHANES) cycle. The exposure was health insurance (private insurance, Medicaid, no insurance), the outcome was untreated dental caries, and the mediator was dental care utilization (dental visit \u2264\u20091\u2009year). We conducted causal mediation analyses and adjusted for age, race\/ethnicity, and family income to poverty ratio. Results are presented on a risk difference scale with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Untreated dental caries prevalence from 2017 to 2020 was 12.8% (95% CI: (9.46%, 16.15%)) among children aged 2\u20136 and 11.7% (95% CI: (9.86%, 13.48%)) among children ages 7\u201318. Children covered by Medicaid\/CHIP had a 7.7% (95% CI: (7.5%, 8.0%)) excess risk of dental caries compared to privately insured children. Dental care utilization statistically significantly mediated this relationship by 8.3%. By contrast, risk of dental caries among children covered by Medicaid\/CHIP was 5.1% (95% CI: (\u22125.6%, \u22124.6%))\n                      <jats:italic>less<\/jats:italic>\n                      than that of uninsured children. Dental care utilization statistically significantly mediated this relationship by 50.9%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dental care utilization remains an important mechanism in reducing untreated dental caries across insurance types, accounting for a substantially larger share of the difference between children covered by Medicaid\/CHIP and uninsured children than between those covered by Medicaid\/CHIP and private insurance. Additional mechanisms beyond utilization likely contribute to differences in untreated dental caries between children covered by Medicaid\/CHIP and private insurance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jphd.70084","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:50:44Z","timestamp":1791507044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Insurance and Untreated Dental Caries Among Children in the United States: The Mediating Role of Dental Care Utilization"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4423-6341","authenticated-orcid":false,"given":"Deesha R.","family":"Bhaumik","sequence":"first","affiliation":[{"name":"Department of Epidemiology Center of Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health  Ann Arbor Michigan USA"},{"name":"Health Policy Institute, American Dental Association  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9981-6250","authenticated-orcid":false,"given":"Sung Kyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0668-1778","authenticated-orcid":false,"given":"Morgan C.","family":"Byrd","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Center of Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2357-7534","authenticated-orcid":false,"given":"Margherita","family":"Fontana","sequence":"additional","affiliation":[{"name":"Department of Cariology Restorative Sciences and Endodontics University of Michigan School of Dentistry  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9677-1632","authenticated-orcid":false,"given":"David W.","family":"Hutton","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6682-238X","authenticated-orcid":false,"given":"Betsy","family":"Foxman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Center of Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Centers for Disease Control and Prevention \u201cCavities \u201dhttps:\/\/www.cdc.gov\/oralhealth\/fast\u2010facts\/cavities\/index.html."},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","unstructured":"E.Riggs N.Kilpatrick L.Slack\u2010Smith et\u00a0al. \u201cInterventions With Pregnant Women New Mothers and Other Primary Caregivers for Preventing Early Childhood Caries \u201d(2019) Cochrane Database of Systematic Reviews John Wiley and Sons Ltd https:\/\/doi.org\/10.1002\/14651858.CD012155.pub2.","DOI":"10.1002\/14651858.CD012155.pub2"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(07)60031\u20102"},{"key":"e_1_2_7_5_1","first-page":"587","article-title":"The U.S. Surgeon General's Report on Oral Health in America: A Canadian Perspective","volume":"67","author":"Lawrence H. P.","year":"2001","journal-title":"Journal"},{"key":"e_1_2_7_6_1","unstructured":"Centers for Disease Control and Prevention \u201cOral Health Surveillance Report: Dental Caries Tooth Retention and Edentulism United States 2017\u2013March 2020 \u201d(2024) https:\/\/www.cdc.gov\/oral\u2010health\/php\/2024\u2010oral\u2010health\u2010surveillance\u2010report\/index.html."},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034520947665"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.3402\/jom.v8.30112"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/003335491012500202"},{"key":"e_1_2_7_10_1","volume-title":"Improving Access to Oral Health Care for Vulnerable and Underserved Populations","author":"Institute of Medicine and National Research Council","year":"2011"},{"key":"e_1_2_7_11_1","unstructured":"C. H.Bersell \u201cAccess to Oral Health Care: A National Crisis and Call for Reform \u201d2017American Dental Hygienists' Association;91(1)."},{"key":"e_1_2_7_12_1","unstructured":"\u201cDental Crisis in America: The Need to Expand Access: Hearing Before the Subcommittee on Primary Health and Aging of the Committee on Health Education Labor and Pensions \u201d(S. Hrg 112\u2013898) U.S. Senate 112th Cong2012."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976\u20109668.107257"},{"key":"e_1_2_7_14_1","unstructured":"\u201cDental Crisis in America: The Need to Address Cost: Hearing Before the Subcommittee on Primary Health and Aging of the Committee on Health Education Labor and Pensions \u201d(S. Hrg 113\u2013811) U.S. Senate 113th Cong.2013."},{"key":"e_1_2_7_15_1","unstructured":"\u201cDental Care | Medicaid \u201d(2021) https:\/\/www.medicaid.gov\/medicaid\/benefits\/dental\u2010care\/index.html."},{"key":"e_1_2_7_16_1","unstructured":"\u201c42 U.S. Code Section\u00a018022(b)(1)(J) \u201d."},{"key":"e_1_2_7_17_1","unstructured":"Centers for Medicaid & Medicare \u201cImproving Access to and Utilization of Oral Health Services for Children in Medicaid and CHIP Programs CMS Oral Health Strategy \u201d(2011)."},{"key":"e_1_2_7_18_1","unstructured":"American Dental Association \u201cDental Care in Medicaid Programs \u201d(2025) https:\/\/www.ada.org\/\u2010\/media\/project\/ada\u2010organization\/ada\/ada\u2010org\/files\/resources\/research\/hpi\/dental_care_in_Medicaid_programs.pdf."},{"key":"e_1_2_7_19_1","unstructured":"Centers for Disease Control and PreventionandU.S. Department of Health and Human Services Centers for Disease Control and Prevention \u201cNational Health and Nutrition Examination Survey Examination Protocols for Disease Control and Prevention \u201d(2021) https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/ContinuousNhanes\/Default.aspx?BeginYear=2013."},{"key":"e_1_2_7_20_1","series-title":"National Center for Health Statistics. Vital Health Statistics, Series 2, No. 190","volume-title":"National Health and Nutrition Examination Survey, 2017\u2013March 2020 Prepandemic File: Sample Design, Estimation, and Analytic Guidelines","author":"Akinbam L.","year":"2022"},{"key":"e_1_2_7_21_1","unstructured":"National Center for Health Statistics \u201cExamination Manuals 2001\u20132002 2003\u20132004 2011\u20132012 2013\u20132014 2015\u20132016 2017\u20132020 \u201d(2023) https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/Default.aspx."},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/idj.12076"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/23800844221121260\/ASSET\/IMAGES\/LARGE\/10.1177_23800844221121260\u2010FIG4.JPEG"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.12511"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1037\/A0020761"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1353\/OBS.2018.0013"},{"issue":"5","key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v059.i05","article-title":"Mediation: R Package for Causal Mediation Analysis","volume":"59","author":"Tingley D.","year":"2014","journal-title":"Journal of Statistical Software"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1214\/10\u2010STS321\/TITLE\/IDENTIFICATION_INFERENCE_AND_SENSITIVITY_ANALYSIS_FOR_CAUSAL_MEDIATION_EFFECTS"},{"key":"e_1_2_7_29_1","unstructured":"Health Resources and Services Administration \u201cAddressing Health Inequities Through Title VII Training Program Training Clinicians to Close the Gaps in Health Equity Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD) \u201d(2023)."},{"key":"e_1_2_7_30_1","unstructured":"Centers for Disease Control and Prevention \u201cSchool Sealant Programs | Division of Oral Health | CDC \u201d(2024) https:\/\/www.cdc.gov\/oralhealth\/dental_sealant_program\/index.htm."},{"key":"e_1_2_7_31_1","unstructured":"S.Baker J.Lee andR.Wright \u201cThe Importance of the Age One Dental Visit \u201d(2019) Pediatric Oral Health Research and Policy Center American Academy of Pediatric Dentistry. Chicago IL."},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.PCL.2018.05.003"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.4103\/JFMPC.JFMPC_286_19"},{"key":"e_1_2_7_34_1","first-page":"22","volume-title":"Oral Health in America: Advances and Challenges","author":"National Institutes of Health","year":"2021"},{"key":"e_1_2_7_35_1","unstructured":"National Institute of Dental and Craniofacial Research \u201cDental Caries (Tooth Decay) in Children Ages 2 to 11\u2009Years \u201d(2024) https:\/\/www.nidcr.nih.gov\/research\/data\u2010statistics\/dental\u2010caries\/children#dental\u2010caries\u2010in\u2010the\u2010primary\u2010teeth\u2010unmet\u2010needs\u2010children\u2010ages\u20102\u2010to\u20105\u2010years."},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/AJCN\/79.1.6"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010198102000\u201000001"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1146\/ANNUREV\u2010PUBLHEALTH\u2010040119\u2010094318"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1034\/J.1600\u20100528.2003.00026.X"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106831\u20106\u2010S1\u2010S4"},{"key":"e_1_2_7_41_1","first-page":"706","volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","author":"VanderWeele T. J.","year":"2015"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006\u20102089D"}],"container-title":["Journal of Public Health Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jphd.70084","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jphd.70084","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jphd.70084","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:50:49Z","timestamp":1791507049000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jphd.70084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":41,"alternative-id":["10.1111\/jphd.70084"],"URL":"https:\/\/doi.org\/10.1111\/jphd.70084","archive":["Portico"],"relation":{},"ISSN":["0022-4006","1752-7325"],"issn-type":[{"value":"0022-4006","type":"print"},{"value":"1752-7325","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"2024-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jphd.70084"}}