International Journal of Dentistry prevalence. Importantly, they suggested that the consump- tion of sugar-sweetened drinks during the ﬁrst two years of birth and the presence of mutans streptococci are the strongest predictors of dental caries among low SES children [17]. Children aged 6–10 years do not diﬀer much from very young children in regard to dental caries and oral health problems. A cross-sectional analytical study of the 2007 National Survey of Children’s Health was conducted [18]. Researchers explained that known states of high percentage of population living in or below poverty level such as Mississippi have more children with dental caries. On the other hand, toothache negatively correlated with per capita dentist supply as it is the case in the Districts of Columbia and Massachusetts. In general, the U.S. children at 200% or low of FPL, minority, and those with special needs are signiﬁcantly at high risk of having oral health problems [18]. In addition to SES, diﬀerent racial and ethnic groups are at high risk of untreated dental decay. For the last ten years, children who are African-Americans and Mexican- Americans have experienced more dental caries than White- Americans [20]. Unfortunately, the gap to decrease oral health disparities between American Indian/Alaska Native populations is huge comparing to the rest of the U.S. populations. American Indian/Alaska Native children aged 2–4 years are ﬁve times more likely to have oral problems compared to other children [20]. 4. Medicaid Medicaid dental coverage and its impact on PDC are going to be brieﬂy discussed in this section. Under Title XIX of the Social Security Act, the federal Medicaid statute was enacted in 1965 [21]. Medicaid is a kind of federal ﬁnancial participation that is “a means-tested, social welfare program that uses tax revenues to provide health coverage for persons who cannot aﬀord private insurance” [22]. Eligibility for Medicaid is restricted to individuals who are U.S. citizens or “qualiﬁed aliens” immigrants with limited income and assets, and others who are specially categorized in need for public assistance such as people with very high medical expenses that exhaust most of their resources [22]. All Medicaid beneﬁciaries are eligible to receive unlim- ited coverage on some particular types of illness; however, their eligibility to receive other certain health services is limited and depends on medical necessity [22]. Individuals who are under age 21 are required to receive EPSDT to be eligible for Medicaid beneﬁts [22]. Having regular dental care services is mediated as part of EPSDT for those under the age of 21 years [6]. Not only dental emergencies are covered under Medicaid, but also reasonable dental beneﬁts which include at least infection and pain relief, build-ups and restoration of teeth infected with dental caries, and oral health maintenance [6]. Oral screening administered during physical exam is not enough. A referral to a dentist followed with dental exami- nation performed by a dentist is required. Medicaid dental services work through intervals at both dental organization 3 intervals to perform oral consultation and medical providers to determine medical necessity. All expenses are covered as long as the term of medical necessity is fulﬁlled [6]. Medicaid funding comes from both federal and state government which makes both governmental levels operate the state Medicaid services [22]. States are required by federal law to provide Medicaid-eligible children, until age of 21 year, with access to EPSDT and eﬀectively utilize available resources [7]. The Oﬃce of Inspector General from the Department of Health and Human Services listed requirements for states to help improving access and utilization of dental services cov- ered under Medicaid [7]. The requirements for states en- rolled in Medicaid, provided by the Oﬃce of Inspector Ge- neral are the following. (1) Medical and dental providers including physicians, dentists, and others should be recruited to participate in EPSDT. (2) Medical and dental examinations, diagnosis, and treatments should be monitored and overlooked. (3) Families who are Medicaid-eligible should be located and informed about EPSDT. (4) The desired services of medical, dental, vision, and hearing screenings should be ﬁt into schedules based on the practice of professional standards. (5) The Health Care Financing Administration (HCFA) should be provided with fully informed report on the utilization of EPSDT services. (6) Any condition requires treatment identiﬁed by a screening and needed services must be provided, whether or not this service is included in the state’s Medicaid plan [7]. As any nonproﬁt task, Medicaid faces a challenge of the rapid increase in expenses with very limited budgetary. This challenge aﬀects the quality and the access to care. Many states ﬁnd the best way to reduce costs is through reducing the amount of reimbursements to very low levels to satisfy the federal statute of suﬃcient payment [22]. This action can highly inﬂuence the decision, as health services provider, to participate in Medicaid. Studies have shown that Medicaid low reimbursements is negatively correlated with the number of dentists par- ticipated in Medicaid. In Alabama, a survey was mailed in 2003 to 518 Medicaid dentists had a response rate of 54% aimed to examine the relationship between Medicaid den- tists and their participation in Medicaid [23]. Researchers included in their conclusion that dentist’ perceptions of Medicaid, such as high reimbursements and quick process of receiving payments have a high inﬂuence on their continuing participation [23]. A similar study conducted in Louisiana found that Med- icaid reimbursements is much less than private payments [24]. Louisiana dentists were not satisﬁed with Medicaid due to low fees, slow mechanism of receiving payments, un- reasonable denial of payments, and complications in ﬁlling paperwork for Medicaid [24].