Access, timing, and impact of dental care on health outcomes in children with sickle cell disease

The National Heart, Lung, and Blood Institute awarded the Regents of the University of Michigan $920,152 on September 1, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to conduct a study examining the access, timing, and impact of dental care on health outcomes in children with sickle cell disease.

The research uses national Medicaid data to determine whether preventive dental care improves outcomes for children with sickle cell disease and whether some children would benefit from additional dental visits to monitor oral health and detect problems early. Aim 1 examines receipt of preventive and other types of dental care among children with sickle cell disease and assesses associations with receipt of care by individual-level factors such as demographics and patterns of healthcare use, community-level factors such as rurality and dentist supply, and state-level factors such as Medicaid payment for dental care and dentist participation in Medicaid. Aim 2 estimates the impact of receipt of preventive dental care on long-term sickle cell disease-related adverse events, including total acute care utilization, pain crises, stroke, and infection, using an instrumental variables estimation approach to address potential selection bias.

The award covers the period of performance from September 1, 2026, through May 31, 2030, with place of performance in Ann Arbor, Michigan. This is a project grant, the standard assistance type for investigator-initiated research at NIH.

Abstract

Sickle cell disease (SCD) affects approximately 100,000 americans, with the majority relying on medicaid for insurance coverage. Children with SCD have complex health care needs and often experience vaso-occlusive crises (i.e., pain crises) that can be severe, unpredictable, and require hospitalization. Preventive dental care is important for all children and particularly for children with SCD due to the reciprocal relationship between SCD and oral health. Despite heightened risks, access to dental care remains critically limited among this population. This study will use national medicaid data to determine if preventive dental care can improve outcomes for children with SCD and if some children with SCD may benefit from additional dental visits to monitor oral health and detect problems early. Aim 1 will examine receipt of preventive dental care, as well as other types of dental care, among children with SCD and assess associations with receipt of care by factors at the individual- (e.g., demographics and patterns of healthcare use), community- (e.g., rurality, dentist supply), and state-levels (e.g., medicaid payment for dental care, dentist participation in medicaid, safety net generosity). Aim 2 will estimate the impact of receipt of preventive dental care on long-term SCD-related adverse events, such as total acute care utilization, pain crises, stroke, and infection. Comparing adverse outcomes following receipt of preventive dental care is challenging due to the potential for selection bias. If children at lower risk of adverse outcomes are more likely to receive preventive dental care, then IT may be mistakenly concluded that dental care reduces adverse outcomes. To address this potential bias, exogenous variation influencing dentist supply for medicaid-enrollees will be exploited by using an instrumental variables (IV) estimation approach using a state-level measure of medicaid payment rates for dentists. Finally, aim 3 will examine the impact of hydroxyurea, a recommended disease modifying therapy, on oral health. Outcomes for children with varying levels of adherence to hydroxyurea will be compared, as well as to children not using hydroxyurea, using regression models with propensity score weighting and examine how impacts vary based on receipt of preventive dental care. This study represents the first large-scale, population-based analysis of dental care patterns and outcomes in pediatric SCD using administrative claims data. The findings will inform evidence-based guidelines for dental care in SCD, support policy initiatives to improve oral health access for this vulnerable population, and provide the foundation for future interventional studies. These results will be directly applicable to healthcare systems, policymakers, and clinicians, and could also help maximize the quality of life of children with SCD.