2 The areas to be covered are the following: ﬁrst, the importance of early childhood preventive dentistry; second, children at high risk of dental caries in the U.S.; third, dental beneﬁts under Medicaid; fourth, accessing and utilizing dental preventive services by Medicaid-eligible children; ﬁfth, contributing factors of preventive dental utilization at micro, meso, and macro levels; sixth, outcome evaluation of Medicaid impact in preventing dental problems among children; lastly, conclusion. 2. Early Childhood Preventive Dentistry The ﬁrst area to be covered is the importance of obtaining early PDC. Children with dental problems such as dental caries or poor oral hygiene face a lot of issues related to their oral health and overall health status. In the U.S., it is estimated that 2% of infants 12 to 23 months of age have at least one tooth with questionable tooth decay and 19% of children 24 to 60 months of age ﬁt into early childhood decay deﬁnition of having dental decay in the ﬁrst 5 years of age or younger [8]. The only U.S. population that has experienced an increase in the level of dental caries is young children [9]. In fact, only 23% of children 8 years or younger had received dental sealants [2] which are placed mainly in the pits and ﬁssures of the occlusal surfaces of individual molars to prevent future dental caries [10]. Children with dental caries usually gain weight much slower than their peers without dental caries. Dental caries can prevent the child from eating and getting proper nu- trition [11]. It is signiﬁcantly approved that kids with early dental caries are more likely to weigh less than 80% of their ideal body weight indicating that having early dental caries may aﬀect a child’s growth in a negative way [12]. Child- ren with early childhood caries (ECC) not only their oral health and overall health are negatively aﬀected, but also diﬀerent ramiﬁcations. For example, with emergency dental visits, a child might miss hours in attending school or learn- ing activities, plus parents may have to excuse from their works. In addition, pain relief visits or emergency dental visits would make a bad impressions in the child’s mind that dental oﬃce is only related to pain. Furthermore, the more severity of oral health status, the more necessity of complex dental treatments which are more expensive than preventive or regular dental visits. Other negative eﬀects of ECC are speech problems, low self-esteem, and low proper concentrate [11]. Dental caries in children are 100% preventable, and fu- ture dental problems might be reduced or eliminated with early proper prevention strategies. Preventive dentistry for kids is identiﬁed as “dental care designed to maintain healthy teeth and prevent problems” [11]. The American Academy of Pediatrics recommends that a child should receive a ﬁrst dental risk assessment at 6 months of age and start dental home practice by the ﬁrst year of age for children at high risk of dental caries [13]. No later than 12 months of age, infants are recommended to see dental professional as their ﬁrst dental visit [14]. Preventive dental care is important in educating the child and the parents, identifying current dental status, and International Journal of Dentistry preventing future dental problems. Dental sealants showed to be eﬀective in reducing the possibility of having dental restorations in sealed molars up to 7 years after placing seal- ants for children at high risk of oral cavities [15]. In addition to placing sealants, the use of ﬂuoride reduces dental caries, and it can be delivered through water, toothpaste, rinses, and professional applications [16]. Regarding costs, children who had received early PDC usually have lower dental-related costs than children who started preventive strategies at a later stage [5]. 3. Children at High Risk The second discussion is the identiﬁcation of children groups who are at high risk of dental problems. Over the last ten year, oral health problems are known to be related to children at diﬀerent ages. More than 30% of children who live below the poverty level do not receive treatments for their dental caries compared to only 6% of their peers who live just at 300% or higher of poverty level [8]. Many studies have shown that young children from low-income families and minority groups are at high risk of having oral health problems [3, 17, 18]. There are many reasons that explain the increasing prevalence of dental problems among children with special needs and who come from low socioeconomic status and minority groups. Vargas and Ronzio wrote a literature review on childhood dental caries disparities published in 2006 [19], and they found that children who are socially disadvantaged of being race/ethnic, minority, low SES, immigrants, and live in rural areas, have experienced an increase in the prevalence of oral diseases. Authors indicated that low-income children are in most need for dental treatments and least likely to be seen by dentists for oral care. Reasons for not seeking dental care include limited resources with diﬀerent priorities and diﬃ- culties in ﬁnding a dentist who accept uninsured or pub- lically insured children. They concluded that interventions to eliminate oral disparities health among children have not reached all low-income children 2–5 years in the community [19]. A following paper on oral health disparities published in 2009 agreed with Vargas and Ronzio [19] that minority, young, poor, and low-income children have experienced greater number of decayed teeth than higher income major- ity children [3]. More than 42% of the total U.S. children population has at least one tooth decay, and more than 25% of 2–6 years were infected. Authors indicated that disparities in receiving dental care still exist between children from high-income families and their peers from low-income families. They found that 40% of low-income children have received dental treatments compared to 54% of higher- income children [3]. Furthermore, a longitudinal study was conducted among young children of low-socioeconomic status (SES) to predict factors that are associated with dental caries besides being from low SES [17]. One hundred and twenty-eight children were followed for 18 months from a rural community in Iowa. They found that sociodemographic and ﬂuoride con- sumptions are statistically not correlated with dental caries