Preventive dental care for children in the United States: a national perspective

Cost-effectiveness of Dental Workforce Expansion Through the National Health Service Corps and Its Association With Oral Health Outcomes Among US Children

Importance

Despite considerable efforts to improve oral health for all, large disparities remain among US children. A dental professional shortage is thought to be among the determinants associated with oral health disparities, particularly for those residing in underserved communities.

Objective

To evaluate the cost-effectiveness of expanding the dental workforce through the National Health Service Corps (NHSC) and associations with oral health outcomes among US children.

Design, Setting, and Participants

A cost-effectiveness analysis was conducted to estimate changes in total costs and quality-adjusted life years (QALYs) produced by increasing the NHSC funding for dental practitioners by 5% to 30% during a 10-year period. A microsimulation model of oral health outcomes using a decision analytic framework was constructed based on oral health and dental care utilization data of US children from 0 to 19 years old. Data from the nationally representative National Health and Nutrition Examination Survey (NHANES, 2011-2016) were linked to county-level dentist supply and oral health professional shortage areas (HPSAs) information. Changes in prevalence and cumulative incidence of dental caries were also estimated. Sensitivity analyses were conducted to assess the robustness of results to variation in model input parameters. Data analysis was conducted from August 1, 2021, to November 1, 2022.

Exposures

Expanding dental workforce through the NHSC program.

Main Outcomes and Measures

Changes in total QALYs, costs, and dental caries prevalence and cumulative incidence.

Results

This simulation model informed by NHANES data of 10 780 participants (mean [SD] age, 9.6 [0.1] years; 5326 [48.8%] female; 3337 [weighted percentage, 57.9%] non-Hispanic White individuals) found that when funding for the NHSC program increased by 10%, dental caries prevalence and total number of decayed teeth were estimated to decrease by 0.91 (95% CI, 0.82-1.00) percentage points and by 0.70 (95% CI, 0.62-0.79) million cases, respectively. When funding for the NHSC program increased between 5% and 30%, the estimated decreases in number of decayed teeth ranged from 0.35 (95% CI, 0.27-0.44) to 2.11 (95% CI, 2.03-2.20) million cases, total QALY gains ranged from 75.76 (95% CI, 59.44-92.08) to 450.50 (95% CI, 434.30-466.69) thousand QALYs, and total cost savings ranged from $105.53 (95% CI, $70.14-$140.83) to $508.23 (95% CI, $598.91-$669.22) million among children residing in dental HPSAs from a health care perspective. Benefits of the intervention accrued most substantially among Hispanic children and children in low-income households.

Conclusions and Relevance

This cost-effectiveness analysis using a decision analytic model suggests that expanding the dental workforce through the NHSC program would be associated with cost savings and a reduced risk of dental caries among children living in HPSAs.

Non-utilization of oral health services and associated factors among children and adolescents: an integrative review

OBJECTIVE

To review publications exploring non-utilization of oral health services and to identify factors associated with non-utilization of oral health services among children and adolescents.

MATERIALS AND METHODS

An integrative review design was adopted. A search was conducted for research articles published during the period from 2000 to April 2021 in five databases, Medline via Ovid, Scopus, CINAHL, Cochrane Library and Web of Science. Inclusion criteria were original articles examining non-utilization of oral health services among 0-19 years old and studies published in peer-reviewed journals in English. Thematic analysis was undertaken to identify common themes. The Newcastle-Ottawa scale was used to evaluate the quality of the studies.

RESULTS

Twenty-one geographically diverse articles were included. Nineteen studies were cross-sectional, one was a prospective cohort and one a case-control study. Non-utilization of dental health services tended to be higher in children than adolescents. There were predisposing (age, gender, ethnicity, parent's level of education), enabling (family income, dental insurance) and need factors (subjective and objective oral health related parameters) that had been shown to be associated with non-utilization of dental services among children and adolescents.

CONCLUSIONS

This integrative review found predisposing, enabling and need factors to be associated with dental health service non-utilization.

Association between the caregivers’ oral health literacy and the oral health of children and youth with special health care needs

Aim

Previous studies have shown that children of caregivers with low oral health literacy (OHL) had more untreated caries than children of caregivers with adequate OHL. However, there is a paucity of information on this relationship among children and youth with special health care needs (CYSHCN). Accordingly, this study aims to assess the association between the caregivers’ OHL and the oral health status of CYSHCN.

Methods

This cross-sectional study was conducted in four schools dedicated for CYSHCN. A 48-item questionnaire gathered information about the demographic and socioeconomic factors, the child/adolescent’s medical condition, dental characteristics, caregiver self-efficacy and the child’s dental attitude. The Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire was used to assess the caregivers’ OHL. The Löe & Silness gingival index (GI) and the Silness & Löe plaque index (PI) were used to assess gingival health and plaque levels, respectively. Directed acyclic graphs (DAGs) were utilized for the selection of the appropriate set of confounding variables for regression analysis. The mean score differences and 95% confidence intervals (CI) were estimated to quantify the associations of the various covariates with oral health outcome variables.

Results

This study included 214 child/caregiver dyads. Most participants were physically disabled (56.1%) followed by children with hearing difficulty (9.8%) and congenital anomalies/syndromes (7.9%). The mean PI and GI of the children was 1.26±0.52 and 1.30±0.47, respectively. The median CMOHK score was 12 and the respondents were dichotomized based on the median value. Low caregiver oral health conceptual knowledge was significantly associated with higher PI scores (β [95% CI] = -0.26 [-0.41, -0.13]; p<0.001. Older participants (12-21-year-olds) had significantly higher plaque scores compared with younger participants (6-12-year-olds) (β [95% CI] = 0.33 [0.18, 0.51]; p<0.001). Participants who brushed their teeth twice or more daily had significantly lower (β [95% CI] = -0.15 [-0.43, -0.01]; p = 0.046). Conceptual knowledge score was not significantly associated with GI.

Conclusion

This study found lower caregiver OHL levels to be associated with higher plaque scores for their child.

Caregivers' report of preventive dental care visits and services for US WIC-participating and non-participating children

OBJECTIVES

To determine whether children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) had more caregiver-reported preventive dental care visits (PDCVs) and preventive dental services (PDS) than nonparticipating children.

METHODS

A secondary data analysis was performed utilizing the National Survey of Children's Health 2017 and 2018 combined datasets. The analytic sample included 10,356 children aged 1-4 years. It was further stratified into three groups by WIC eligibility and participation to include WIC participation, income-eligible nonparticipants, and higher-income nonparticipants. The independent variables included child-level characteristics (age, sex, race/ethnicity, and insurance) and caregiver-level characteristics (age of mother and the highest level of education in the household). The dependent variable was the report of PDCV and PDS (dental cleaning, toothbrushing instructions, and fluoride treatment) in the past 12 months.

RESULTS

Of the 10,356 children aged 1-4 years, 3025 were eligible for WIC and nearly half of those eligible (49.5%) reported participating in the WIC program. Caregivers of WIC-participating children had a higher reported prevalence of PDCV for their children than those of income-eligible nonparticipants (57.6% vs. 49.6%, respectively) (p < 0.05). In addition, caregivers of WIC-participating children reported their children receiving more PDS than income-eligible nonparticipants, including dental cleanings (38.5% vs. 33.6%), toothbrushing instructions (25.5% vs. 22.7%), and fluoride treatments (22.7% vs. 21.2%) (p < 0.05).

CONCLUSIONS

WIC-participating children had a higher reported prevalence of PDCVs and PDS than income-eligible nonparticipating children. Further research is needed to understand differences in the reports of specific PDSs received.

Association between population-based fluoride varnish application services and dental caries experience among schoolchildren in Taiwan

BACKGROUND/PURPOSE

Taiwan government has provided population-based fluoride varnish application services for all preschool children since July 2004. This study investigated the association providing such services on dental caries experiences among schoolchildren.

METHODS

A cross-sectional study was conducted on schoolchildren aged 8-9 years. A questionnaire collected information on sociodemographic background, parents' oral health status, children's oral health-related behavior, and dietary habits. Dental caries was recorded through standardized oral examinations. The number of services was retrieved from the Taiwan National Health Insurance Research Database. Univariate, multivariable linear, and logistic regression analyses were performed.

RESULTS

The study involved 1246 children. The mean dental caries indices were 3.97 for decayed, extracted, and filled teeth (deft) and 0.94 for decayed, missing and filled teeth (DMFT). After adjustments for confounding factors, it was revealed that children receiving services were not associated with significantly lower deft and DMFT indices (P > 0.05). The adjusted odds ratio (OR) for untreated primary teeth of children receiving 3 or more services was 0.64 (95% CI = 0.44-0.95) compared with those who received no services (P = 0.025). However, subgroup analyses demonstrated that children in the low-risk group were mainly affected (adjusted OR = 0.36-0.89, P = 0.013).

CONCLUSION

This study revealed that children receiving 3 or more services were associated with a 36% decreased risk of having untreated caries in primary dentition, but these children were mainly in the low-risk group. These results illustrate real data that provides dentists and policymakers with valuable information.

Oral Health Among Children and Youth With Special Health Care Needs

OBJECTIVES

We sought to estimate the prevalence of oral health problems and receipt of preventive oral health (POH) services among children and youth with special health care needs (CYSHCN) and investigate associations with child- and family-level characteristics.

METHODS

We used pooled data from the 2016-2018 National Survey of Children's Health. The analytic sample was limited to children 1 to 17 years old, including 23 099 CYSHCN and 75 612 children without special health care needs (non-CYSHCN). Parent- and caregiver-reported measures of oral health problems were fair or poor teeth condition, decayed teeth and cavities, toothaches, and bleeding gums. POH services were preventive dental visits, cleanings, tooth brushing and oral health care instructions, fluoride, and sealants. Bivariate and multivariable logistic regression analyses were conducted.

RESULTS

A higher proportion of CYSHCN than non-CYSHCN received a preventive dental visit in the past year (84% vs 78%, P < .0001). Similar patterns were found for the specific preventive services examined. However, CYSHCN had higher rates of oral health problems compared with non-CYSHCN. For example, decayed teeth and cavities were reported in 16% of CYSHCN versus 11% in non-CYSHCN (P < .0001). In adjusted analyses, several factors were significantly associated with decreased prevalence of receipt of POH services among CYSHCN, including younger or older age, lower household education, non-English language, lack of health insurance, lack of a medical home, and worse condition of teeth.

CONCLUSIONS

CYSHCN have higher rates of POH service use yet worse oral health status than non-CYSHCN. Ensuring appropriate use of POH services among CYSHCN is critical to the reduction of oral health problems.

Dental Visits and Predictors of Regular Attendance Among Female Schoolchildren in Dammam, Saudi Arabia

Purpose

Regular dental visits are important for the maintenance of optimal oral health and improved quality of life. The purpose of the study was to evaluate patterns of dental visits and factors associated with routine dental attendance among female schoolchildren in Dammam, Saudi Arabia.

Patients and Methods

This cross-sectional study was performed on 449 female primary schoolchildren (6–11 years old) in Dammam, Saudi Arabia. The study included clinical examination for decay in the first permanent molars in children and questionnaire administration among their parents. The World Health Organization’s oral health questionnaire was used to collect data about children’s dental visits, oral hygiene behaviors, dental problems, and dietary practices. Bivariate and multivariate analyses were performed to evaluate factors associated with routine dental visits.

Results

Most children (64.1%) visited the dentist during the past one year, 22.1% performed no dental visit during the past one year, and 8.3% never visited the dentist. Among children who visited the dentist, the pain was the most common reason for dental visits (39.10%, N=170), followed by routine dental check-ups (18.60%, N=81). In bivariate analysis, education of parents, family income, daily tooth brushing, no decay in the first permanent molar, no toothache, no consumption of soft drinks, biscuits, cakes, and cream were significantly associated with routine dental attendance (P <0.05). However, the final logistic regression model showed that university education of mothers (OR 2.52, P = 0.005), not having toothache or discomfort (OR 2.88, P = 0.001), tooth brushing once or twice daily (OR 2.43, P= 0.034), and not consuming soft drinks (OR 1.96, P= 0.027) were significant predictors of routine dental visits.

Conclusion

The study found that higher education of mothers, daily tooth brushing, not having dental pain, and not consuming soft drinks were significantly associated with routine dental visits in this sample of female schoolchildren. Routine dental attendance may be used to improve oral hygiene and reduce dental pain and consumption of soft drinks in children.

A Machine Learning Approach to Uncovering Hidden Utilization Patterns of Early Childhood Dental Care Among Medicaid-Insured Children

Background: Early childhood dental care (ECDC) is a significant public health opportunity since dental caries is largely preventable and a prime target for reducing healthcare expenditures. This study aims to discover underlying patterns in ECDC utilization among Ohio Medicaid-insured children, which have significant implications for public health prevention, innovative service delivery models, and targeted cost-saving interventions.

Methods: Using 9 years of longitudinal Medicaid data of 24,223 publicly insured child members of an accountable care organization (ACO), Partners for Kids in Ohio, we applied unsupervised machine learning to cluster patients based on their cumulative dental cost curves in early childhood (24–60 months). Clinical validity, analytical validity, and reproducibility were assessed.

Results: The clustering revealed five novel subpopulations: (1) early-onset of decay by age (0.5% of the population, as early as 28 months), (2) middle-onset of decay (3.0%, as early as 35 months), (3) late-onset of decay (5.8%, as early as 44 months), (4) regular preventive care (67.7%), and (5) zero utilization (23.0%). Patients with early-onset of decay incurred the highest dental cost [median annual cost (MAC) = $9,499, InterQuartile Range (IQR): $7,052–$11,216], while patients with regular preventive care incurred the lowest dental cost (MAC = $191, IQR: $99–$336). We also found a plausible correlation of early-onset of decay with complex medical conditions diagnosed at 0–24 months. Almost one-third of patients with early-onset of decay had complex medical conditions diagnosed at 0–24 months. Patients with early-onset of decay also incurred the highest medical cost (MAC = $7,513, IQR: $4,527–$12,546) at 0–24 months.

Conclusion: Among Ohio Medicaid-insured children, five subpopulations with distinctive clinical, cost, and utilization patterns were discovered and validated through a data-driven approach. This novel discovery promotes innovative prevention strategies that differentiate Medicaid subpopulations, and allows for the development of cost-effective interventions that target high-risk patients. Furthermore, an integrated medical-dental care delivery model promises to reduce costs further while improving patient outcomes.

Impact of Pediatric Dentistry Residents Posted in Pediatrics Department: A Retrospective Assessment of 6 Years

Aim

To measure the influence of rotatory pediatrics postings for dental residents on the outpatient census of the pediatric dentistry department. The secondary aims were to assess the change in trend toward the number of preschool children visiting the department before and after the initiation of pediatrics posting and also to find the percentage of children affected with caries among children visiting the pediatricians.

Materials and methods

Retrospectively, the census of the pediatric dentistry department was calculated from 2010 to 2016. The number of preschool children who visited the pediatric dentistry department during this period was determined. From the pediatrics posting records, the dental status of the children, the number screened, the number referred, and the number reported to dentistry following referral were tabulated. Descriptive statistics and Chi-square tests were performed.

Results

After the initiation of pediatrics postings for residents, the outpatient census has increased by 26%. There was a significant increase in the number of preschool children visiting the pediatric dentist. About 57.09% of children screened in the pediatrics department had dental disease.

Conclusion

There is an increase in the patient flow of the pediatric dentistry department with a greater number of preschool children visiting the pediatric dentist after initiation of the pediatrics postings for residents. More than half the children visiting pediatricians had dental disease requiring professional care.

Clinical significance

Pediatrics postings for residents can be used in teaching centers as an opportunity to spread awareness and increase the number of preschool children visiting pediatric dentists, thereby increasing prevention and early intervention of early childhood caries.

How to cite this article

Mohan A, Muthu MS, Ramachandran P, et al. Impact of Pediatric Dentistry Residents Posted in Pediatrics Department: A Retrospective Assessment of 6 Years. Int J Clin Pediatr Dent 2021;14(1):84–87.

Income-Based Disparities in a Yearly Dental Visit in United States Adults and Children: Trend Analysis 1997 to 2016

OBJECTIVE

To determine how income-based disparities in a yearly dental visit (the Healthy People 2020 Leading Health Indicator for Oral Health) changed since legislation to expand dental coverage and to compare disparity trends in children and adults.

METHODS

We analyzed Medical Expenditure Panel Survey 1997 to 2016 to determine yearly dental visit rates for US children and adults by family income. We determined measures of income disparity, including the Slope Index of Inequality and the Relative Index of Inequality and examined trends in yearly dental visit, Slope Index of Inequality, and Relative Index of Inequality using joinpoint regression.

RESULTS

Income-based disparities, absolute and relative, narrowed over time for children. Steady upward trends in yearly dental visit rates were observed for poor and low-income/poor children and no joinpoint was identified that corresponded to legislation expanding dental care coverage for lower income children. Relative income-based disparities in yearly dental visit rates widened for adults over 20 years. After declining for 14 years, yearly dental visit rate increased for poor adults from 2013 to 2016 suggesting a possible positive effect in adult dental care use trends following enactment of the Affordable Care Act.

CONCLUSIONS

In 1997, US children and adults had similar levels of income-based disparity in yearly dental visits, but by 2016, they differed markedly. Trends in income-based disparities in yearly dental visit rate narrowed for children but widened for adults. There are lessons from the expansion of dental care coverage for children that could be applied to improve access to dental care for adults.

Preventive oral health care use and oral health status among US children: 2016 National Survey of Children's Health

BACKGROUND

Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children's preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics.

METHODS

Data for this observational, cross-sectional study came from the 2016 National Survey of Children's Health. Children aged 2 through 17 years were included (n = 46,100). Caregiver-reported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted.

RESULTS

As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care.

CONCLUSIONS

Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services.

PRACTICAL IMPLICATIONS

Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds.

Caregiver Burdens and Preventive Dental Care for Children with Autism Spectrum Disorder, Developmental Disability and/or Mental Health Conditions: National Survey of CSHCN, 2009-2010

Objective The purpose of this study is to examine the burdens of caregivers on perception of the need and receipt of preventive dental care for a subset of children with special health care needs-children with Autism Spectrum disorder, developmental disability and/or mental health conditions (CASD/DD/MHC). Methods The authors used the 2009-2010 National Survey of CSHCN. The survey included questions addressing preventive dental care and caregivers' financial, employment, and time-related burdens. The associations of these burdens on perceptions and receipt of preventive dental care use were analyzed with bivariate Chi square analyses and multinomial logistic regressions for CASD/DD/MHC (N = 16,323). Results Overall, 16.3 % of CASD/DD/MHC had an unmet preventive dental care need. There were 40.0 % of caregivers who reported financial burden, 20.3 % who reported employment burden, and 10.8 % who reported time burden. A higher percentage of caregivers with financial burden, employment burden, and time-related burden reported that their CASD/DD/MHC did not receive needed preventive dental care (14.1, 16.5, 17.7 % respectively) compared to caregivers without financial, employment, or time burdens (9.0, 9.6 %, 11.0 % respectively). Caregivers with financial burden (adjusted multinomial odds ratio, 1.38 [95 % CI 1.02, 1.86] and employment burden (adjusted multinomial odds ratio, 1.45 [95 % CI 1.02, 2.06] were more likely to report that their child did not receive preventive dental care despite perceived need compared to caregivers without financial or employment burdens. Conclusions for practice Unmet needs for preventive dental care were associated with employment and financial burdens of the caregivers of CASD/DD/MHC.

Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers

OBJECTIVES

To assess an oral health promotion (OHP) intervention for medical providers' impact on early childhood caries (ECC).

METHODS

We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention's impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models.

RESULTS

Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0-7), and 4.5 (4-7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts.

CONCLUSIONS

An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years.

Impact of AHA's 2007 guideline change on incidence of infective endocarditis in infants and children

Use a nationally representative sample to assess impacts of new clinical guidelines issued by the American Heart Association (AHA) in 2007 for many types of invasive procedures, with recommendations for significant decreases in antimicrobial prophylaxis use.

STUDY DESIGN

Interrupted time series analyses of pediatric hospitalizations for Infective Endocarditis (IE), using the Nationwide Inpatient Sample (NIS) ICD-9-CM diagnostic codes, identified IE hospitalizations for patients <18 years old from 2001 to 2012. Changes in IE incidence before and after 2007 AHA guidelines were evaluated, with differences in IE clinical severity assessed using in-hospital mortality and length of stay. Analyses were stratified by pathogen type and age group (0-9 y/o and 10-17 y/o).

RESULTS

With 3,748 patients in the study, we observed rising trends in IE incidence, but no significant difference between pre- and post-guideline. There was a significant trend increase for IE due to viridans group streptococci (VGS) for ages >10 years old, comparing pre-guideline to post-guideline periods, but not in children 0-9 years of age. Neither in-hospital mortality nor length of stay changed significantly during study.

CONCLUSIONS

The data did not demonstrate an impact of the 2007 guideline changes on overall incidence of pediatric IE. However, a significant increase in disease incidence trend due to VGS was observed for the 10-17 year-old group, compared pre- and post-guideline.

The Effects of Distance to Dentists and Dentist Supply on Children's Use of Dental Care

OBJECTIVE

To examine the effects of distance to dentists and dentist supply on dental services use among children with Medicaid coverage in Iowa.

DATA SOURCE

Iowa Medicaid claims for enrolled children between 2000 and 2009.

STUDY DESIGN

The study sample included 41,554 children (providing 158,942 child-year observations) who were born in Iowa between 2000 and 2006 and enrolled from birth in the Iowa Medicaid program. Children were followed through 2009. We used logistic regression to simultaneously examine the effects of distance (miles to nearest dentist) and county-level dentist supply on a broad range of dental services controlling for key confounders. Additional models only used within-child variation over time to remove unobservable time-invariant confounders.

PRINCIPAL FINDINGS

Distance was related to lower utilization of comprehensive dental exams (2 percent lower odds per 1 mile increase in distance), an effect that also held in models using within-child variation only. Dentist supply was positively related to comprehensive exams and other preventive services and negatively related to major dental treatments; however, these associations became smaller and insignificant when examining within-child changes except for other preventive services.

CONCLUSIONS

Longer distance to dentists is a barrier for use of comprehensive dental exams, conditional on dentist supply.

Oral health services within community-based organizations for young children with special health care needs

PURPOSE

To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a nonfluoridated community.

METHODS

Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision.

RESULTS

We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program.

CONCLUSIONS

Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN.

Factors affecting children's adherence to regular dental attendance: a systematic review

BACKGROUND

Parents' adherence to regular dental attendance for their young children plays an important role in improving and maintaining children's oral health. The authors conducted a systematic review to determine the factors that influence parental adherence to regular dental attendance for their children.

TYPE OF STUDIES REVIEWED

The authors searched nine electronic databases to May 2013. They included quantitative and qualitative studies in which researchers examined factors influencing dental attendance in children 12 years or younger. The authors considered all emergency and nonemergency visits. They appraised methodological quality through the Health Evidence Bulletins Wales methodological quality assessment tool.

RESULTS

The authors selected 14 studies for the systematic review. Researchers in these studies reported a variety of factors at the patient, provider and system levels that influenced dental attendance. Factors identified at the patient level included parents' education, socioeconomic status, behavioral beliefs, perceived power and subjective norms. At the provider level, the authors identified communication and professional skills. At the system level, the authors identified collaborations between communities and health care professionals, as well as a formal policy of referring patients from family physicians and pediatricians to dentists.

PRACTICAL IMPLICATIONS

Barriers to and facilitators of parents' adherence to regular dental attendance for their children should be identified and considered when formulating health promotion policies. Further research is needed to investigate psychosocial determinants of children's adherence to regular dental visits.

Evaluation of school-based prevention program in Turkey: Results of a 24-month study

Objective:

In this paper, cavity experiences of children with different levels of eruption and cavity activities that are enrolled at an elementary school with semi-rural characteristics in Kırıkkale Provincial center were monitored for 2 years after a variety of protective applications.

Materials and Methods:

Three hundred and twenty-two children at the age of 7–11 were included in this study. Children were grouped as follows according to their cavity experiences and applications done: Group 1 - control group (with or without cavities) – was given hygiene training only; Group 2 - with medium level cavity activity (2–4 cavities in average) – oral hygiene training + surface restoration applied; Group 3 - children with 2–4 cavities on average – oral hygiene training + professional flour gel applied; Group 4 - children with 2–4 cavities in average – oral hygiene training + flour gel applied with brush; Group 5 - children with extreme cavity activity (children with 5 or more cavities) – oral hygiene training + surface restoration + professional flour gel combination applied.

Results:

At the end of the 2^nd year, 277 children were reached. The increase of number of cavities in permanent teeth was determined as 35%, 0%, 1%, 0%, and 7% in groups 1–5, respectively. The difference between groups was found to be significant (Chi-square analysis, Pearson Chi-square = 27.002, P < 0.01).

Conclusion:

These findings have showed that, in Kırıkkale Provincial center, some cavity-preventive measures such as surface restoration and gel applications, along with hygiene training, could provide optimum protection for school-age children.

The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits

Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte's method of categorizing people's perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child's age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.

Impact of an interprofessional oral health education program on health care professional and practice behaviors: a RE-AIM analysis

BACKGROUND

Early childhood caries is the most common chronic childhood condition and largely preventable. Access to oral health preventive services (OHPS) for children at risk for caries is suboptimal and could be expanded if they were provided by non-dental professionals. Many state Medicaid programs in the USA now reimburse non-dental professionals for OHPS but require that they receive oral health education (OHE) to be reimbursed. Few OHE programs have been evaluated.

METHODS

We evaluated the impact of Colorado's OHE program on professional- and practice-level behaviors regarding the provision of OHPS to children by measuring its reach, effectiveness, adoption, implementation, and maintenance (ie, using the Reach Effectiveness Adoption Implementation Maintenance [RE-AIM] framework) with Medicaid claims data, online surveys, and key informant interviews.

RESULTS

From 2009 to 2012, the proportion of young, low-income children receiving OHPS from a medical professional increased 16-fold. We surveyed 703 OHE participants; post-OHE response rates were 61% at 12 months, 34% at 24 months (2009 participants), and 39% at 12 months (2011 participants). Respondents reported confidence in providing OHPS; favorable oral health knowledge, attitudes, and beliefs; and were providing OHPS to most eligible children. Approximately half of the practices had initiated practice-level changes to support program implementation and maintenance. Few barriers were reported to care. Eighteen interviewees reported factors facilitating program diffusion, which included quality materials, community need, and reimbursement; barriers included lack of time to provide services, resources to purchase supplies, and referral dentists.

CONCLUSION

This evaluation of a state interprofessional OHE program shows evidence of program diffusion and identifies facilitating factors and barriers to having medical professionals provide OHPS.

Dentist supply and children's oral health in the United States

OBJECTIVES

We evaluated the relationship between dentist supply and children's oral health and explored heterogeneity by children's age and urbanicity.

METHODS

We obtained data from the 2007 National Survey of Children's Health (>27,000 children aged 1-10 years; >23,000 children aged 11-17 years). We estimated the association between state-level dentist supply and multiple measures of children's oral health using regression analysis adjusting for several child, family, and population-level characteristics.

RESULTS

Dentist supply was significantly related to better oral health outcomes among children aged 1 to 10 years. The odds of decay and bleeding gums were lower by more than 50% (odds ratio [OR]=0.46; 95% CI=0.23, 0.95) and 80% (OR=0.18; 95% CI=0.05, 0.76), respectively, with an additional dentist per 1000 population. The odds of a worse maternal rating of child's dental health on a 5-category scale from poor to excellent were lower by about 50% in this age group with an additional dentist per 1000 population (OR=0.51; 95% CI=0.29, 0.91). We observed associations only for children in urban settings.

CONCLUSIONS

Dentist supply is associated with improved oral health for younger children in urban settings.

Influence of caregivers and children's entry into the dental care system

OBJECTIVES

Early preventive dental visits are essential in improving children's oral health, especially young children at high risk for dental caries. However, there is scant information on how these children enter the dental care system. Our objectives were as follows: (1) to describe how a population-based cohort of young Medicaid-enrolled children entered dental care; and (2) to investigate the influence of caregiver characteristics on their children's dental care-seeking patterns.

METHODS

We relied on Medicaid claims and interview data of caregiver-child dyads who were enrolled in the Carolina Oral Health Literacy study during 2007-2008. The analytical cohort comprised 1000 children who had no dental visits before enrollment. Additional information was collected on sociodemographic characteristics, oral health status, health literacy, dental neglect, and access to care barriers. Our analyses relied on descriptive, bivariate, and multivariate methods.

RESULTS

During the 25-month median follow-up period, 39% of the children (mean baseline age: 16 months) entered the dental care system, and 13% of their first encounters were for emergency care. Caregivers' dental neglect emerged as a significant predictor of nonentrance. Children with reported oral health problems at baseline were more likely to enter the dental care system compared with children with better oral health, but they were also more likely to require emergency care.

CONCLUSIONS

Caregivers have a pivotal role in children's oral health and care. Interventions aimed at improving children's oral health should involve community outreach to engage caregivers in a culturally appropriate manner when their children are infants or toddlers.

Child- and state-level characteristics associated with preventive dental care access among U.S. children 5-17 years of age

The objectives of this study is to identify factors associated with lack of preventive dental care among U.S. children and state-level factors that explain variation in preventive dental care access across states. We performed bivariate analyses and multilevel regression analyses among 68,350 children aged 5-17 years using the 2007 National Survey of Children's Health data and relevant state-level data. Odds ratios (ORs) for child- and state-level variables were calculated to estimate associations with preventive dental care. We calculated interval odds ratios (IOR), median odds ratios (MOR), and intraclass correlation coefficients (ICC) to quantify variation in preventive dental care across states. Lack of preventive dental care was associated with various child-level factors. For state-level factors, a higher odds of lack of preventive dental care was associated with a higher percentage of Medicaid-enrolled children not receiving dental services (OR = 1.30, 95 % confidence interval (CI): 1.15-1.47); higher percentage of children uninsured (OR = 1.48, 95 % CI: 1.29-1.69); lower dentist-to-population ratio (OR = 1.36, 95 % CI: 1.03-1.80); and lower percentage of dentists submitting Medicaid/State Children's Health Insurance Program claims (OR = 1.04, 95 % CI: 1.01-1.06). IORs for the first three state-level factors did not contain one, indicating that these state-level characteristics were important in understanding variation across states. Lack of preventive dental care varied by state (MOR = 1.40). The state-level variation (ICC = 3.66 %) accounted for a small percentage of child- and state-level variation combined. Child- and state-level characteristics were associated with preventive dental care access among U.S. children aged 5-17 years. State-level factors contribute to variation in dental care access across states and need to be considered in state-level planning.

Effectiveness of preventive dental visits in reducing nonpreventive dental visits and expenditures

BACKGROUND AND OBJECTIVE

Although preventive dental visits are considered important for maintaining pediatric oral health, there is relatively little research showing that they reduce subsequent nonpreventive dental visits or costs. At least 1 study seemed to find that early preventive dental care is associated with more restorative and emergency visits. Previous studies are limited by their inability to account for unmeasurable factors that may lead children to "select" into using both more preventive and nonpreventive dental care. We used econometric techniques that minimize selection bias to assess the effectiveness of preventive dental care in reducing subsequent nonpreventive dental service utilization among children.

METHODS

Using data from Alabama's Children's Health Insurance Program (CHIP), 1998-2010., a cohort study of children's dental service utilization was conducted. Outcomes were 1-year lagged nonpreventive dental care and expenditures, and overall dental and medical expenditures. Children who were continuously enrolled for at least 3 years were included. Separate models were estimated for children aged <8 years (n = 14 972) and those aged ≥8 years (n = 21 833).

RESULTS

More preventive visits were associated with fewer subsequent nonpreventive dental visits and lower nonpreventive dental expenditures for both groups. However, more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures.

CONCLUSIONS

Preventive dental visits can reduce subsequent nonpreventive visits and expenditures for children continuously enrolled in CHIP. However, they may not reduce overall program costs. Effective empirical research in this area must continue to address unobserved confounders and selection issues.

Associations of the type of childcare with reported preventive medical and dental care utilization for 1- to 5-year-old children in the United States

OBJECTIVE

Despite that the majority of US children use nonparental childcare (NPC), research examining its effects on children's preventive healthcare utilization is lacking. Our aim was to contrast NPC against parental childcare in terms of preventive medical and dental care utilization.

METHODS

Associations of childcare and healthcare utilization were evaluated using the 2007 National Survey of Children's Health, a telephone interview of parent-reported children's health (22,773 children ages 1- to 5-year old). The type of childcare was categorized as parental care, center-based care (CBC), nonrelative home care (NRHC), relative care (RCC), and mixed care (MCC). The outcome measures were preventive medical care (≥ 1 physical examination/well child check-up visit) and preventive dental care (≥ 1 check-ups/dental cleanings visit) during the past 12 months.

RESULTS

Overall, 94.7% of 1- to 5-year-old children received preventive medical care, while only 53.6% received preventive dental care. The highest odds for preventive medical care was for 1- to 2-year-old children utilizing CBC [Odds Ratio (OR) = 2.85, 95% CI = 1.11-7.30] and for 3- to 5-year-old children utilizing MCC (OR = 2.00, 95% CI = 1.23-3.26) followed by CBC (OR = 1.66, 95% CI = 1.13-2.42). Considering preventive dental care, a statistically significant increase occurred for 1- to 2-year-old children with CBC (OR = 1.93, 95% CI = 1.62-2.30), and none occurred for any NPC above the parental childcare rates for 3- to 5-year-old children.

CONCLUSIONS

Childcare use, particularly center-based care, may provide a means to raise preventive healthcare utilization for young children. Future regulations, as well as policy and program development, should consider promoting childcare settings as a means to improve preventive health care utilization.

Racial/ethnic disparities in health and health care among U.S. adolescents

OBJECTIVE

To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents.

DATA SOURCE

Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0-17 years old.

STUDY DESIGN

Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10-17 years old (n = 48,742) to identify disparities in 40 measures of health and health care.

PRINCIPAL FINDINGS

Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth.

CONCLUSIONS

U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.

Encouraging early preventive dental visits for preschool-aged children enrolled in Medicaid: using the extended parallel process model to conduct formative research

OBJECTIVE

Preventive dental visits for preschool-aged children can result in better oral health outcomes, especially for children from lower income families. Many children, however, still do not see a dentist for preventive visits. This qualitative study examined the potential for the Extended Parallel Process Model (EPPM) to be used to uncover potential antecedents to parents' decisions about seeking preventive dental care.

METHODS

Seventeen focus groups including 41 parents were conducted. The focus group protocol centered on constructs (perceived severity, perceived susceptibility, perceived self-efficacy, and perceived response efficacy) of the EPPM. Transcripts were analyzed by three coders who employed closed coding strategies.

RESULTS

Parents' perceptions of severity of dental issues were high, particularly regarding negative health and appearance outcomes. Parents perceived susceptibility of their children to dental problems as low, primarily because most children in this study received preventive care, which parents viewed as highly efficacious. Parents' self-efficacy to obtain preventive care for their children was high. However, they were concerned about barriers including lack of dentists, especially dentists who are good with young children.

CONCLUSIONS

Findings were consistent with EPPM, which suggests this model is a potential tool for understanding parents' decisions about seeking preventive dental care for their young children. Future research should utilize quantitative methods to test this model.

Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid

OBJECTIVES

To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED).

METHODS

This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist.

RESULTS

We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 to <50 years) and enrollees living in counties with a lower supply of dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit.

CONCLUSIONS

Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions.

Racial disparity trends in children's dental visits: US National Health Interview Survey, 1964-2010

BACKGROUND AND OBJECTIVE

Research that has repeatedly documented marked racial/ethnic disparities in US children's receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children's receipt of dental care from 1964 to 2010.

METHODS

We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: child's receipt of a dental visit in the previous 12 months and child's history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ(2) tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census.

RESULTS

The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in children's dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010.

CONCLUSIONS

We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of children's receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in children's oral health status are eliminated.

State of dental care among Medicaid-enrolled children in the United States

OBJECTIVE

To evaluate the prevalence of dental care visits (DCV) in 2007 in the United States among Medicaid-enrolled children from birth to age 18 and measure progress since 2002.

METHODS

By using Medicaid research files and information from the Centers for Medicare & Medicaid Services 416 Early Periodic Screening, Diagnostic, and Treatment forms, we calculated the prevalence of DCV in 50 states and the District of Columbia, stratifying by age, race, type of health plan, and Children's Health Insurance Program status.

RESULTS

The prevalence of having DCV ranged from 12% depending on age, to 49% with a median value of 33% but did not exceed 50% in any state. The median percent change between 2002 and 2007 was 16%. DCV among toddlers and infants were low in all but 3 states and in most states peaked at age of school entry to >60% in some states. In most states, there were few racial differences in the prevalence of DCV. Children enrolled in Primary Care Case Management tended to have the highest DCV, the effect of Children's Health Insurance Program enrollment on the number of DCV was generally positive.

CONCLUSIONS

To our knowledge, this is the first study to evaluate the prevalence of dental care by using paid Medicaid claims. Consistent with other reports, levels of DCV were low; but when the number of DCV was stratified by age and type plan, striking patterns emerged suggesting that a combination of school programs and having a medical home may have a positive impact on dental care.

Self-reported dental hygiene, obesity, and systemic inflammation in a pediatric rural community cohort

BACKGROUND

A growing body of epidemiologic evidence links oral health, obesity, and cardiovascular health, though few studies have reported on these relationships in children. While underlying mechanisms are unclear, adult studies have suggested sub-acute systemic inflammation, also implicated in the etiology of both obesity and cardiovascular disease. This study investigated associations between self-reported dental hygiene, obesity, and systemic inflammation in children.

METHODS

128 children < 19 years of age from rural counties in West Virginia participated in a community-based health screening that included anthropometric assessments, blood collection, and a questionnaire about dental hygiene and self-assessed oral health.

RESULTS

Participants ranged from 3.0-18.7 years. Univariate analysis demonstrated an association between parent-reported dental hygiene, including frequency of preventive dental care and parent-assessed overall dental health, and markers of systemic inflammation but not obesity. In multivariable regression, parent-assessed overall dental health and obesity were independent predictors of systemic inflammation, after adjustment for age, gender, and parent education.

CONCLUSIONS

This is the first known study of the association between dental hygiene, obesity, and systemic inflammation in children. These results highlight the importance of preventive dental care in overall, systemic health in children and are consistent with previous reports in adults.

Primary language spoken at home and children's dental service utilization in the United States

OBJECTIVE

Language barriers have been well documented as a contributing factor to disparities in the receipt of medical services, especially for Hispanic children. However, there is a paucity of information on the effect of language barriers on children's dental service utilization. We examined the association of primary language spoken at home with the receipt of preventive and routine dental care for children in the United States.

METHODS

We analyzed data from the Medical Expenditure Panel Survey (2002-2004), which contains data on 21,049 children weighted to represent 75.8 million children nationally.

RESULTS

Among children aged 1-18 years, 13 percent spoke a language other than English at home. Whites, females, children between the ages of 7 and 12 years, and those whose parents spoke English at home had the highest marginal rates of preventive and routine dental visits. However, the large marginal effect of language, even among Hispanics, was not significant after adjusting for other covariates. Parental education and having a primary provider were the strongest predictors of preventive and routine dental visits.

CONCLUSION

Children that did not speak English at home were less likely to receive preventive or routine dental care. However, after adjusting for other socio-economic factors, our study suggests that language barriers may not play as pronounced a role in the receipt of dental care as that documented for medical services.

Association between parents' and children's use of oral health services

OBJECTIVE

Several parental factors influence children's use of oral health services. Some localized studies have shown that children's dental use patterns correlate positively with those of their parents. The objective of this study was to investigate associations between parents' and children's oral health-seeking behaviors among a representative sample of US children.

METHODS

We used the 2007 National Health Interview Survey to analyze a sample of children aged 2 to 17 years, matched with 1 parent. Using logistic regression, we examined associations between parents' and children's use of dental services and deferred dental care because of cost.

RESULTS

The sample included 6107 child-parent pairs. Overall, 77% of children and 64% of parents had a dental visit in the previous 12 months. Adjusting for sociodemographic and use variables, children were more likely to have a dental visit when their parents also had a dental visit (adjusted odds ratio: 3.36 [95% confidence interval: 2.71-4.18]), compared with children of parents who did not have a dental visit. In addition, compared with children of parents who did not defer seeking dental care, children of parents who deferred their dental care because of cost were more likely to have care deferred because of cost as well (adjusted odds ratio: 12.47 [95% confidence interval: 9.09-17.11]).

CONCLUSIONS

Parental oral health-seeking behaviors for themselves may have an important effect on oral health-seeking behaviors on behalf of their children, regardless of the child's insurance status. Comprehensive strategies to eliminate barriers that target parents and not just children may help to address children's underuse of oral health services.

Oral health and pediatricians: results of a national survey

OBJECTIVE

Pediatricians have regular opportunities to perform screening dental examinations on young children and to educate families on preventive oral health. We sought to assess pediatricians' current attitudes and practices related to oral health of children 0-3 years old.

METHODS

A Periodic Survey of Fellows, focused on oral health in pediatricians' office settings, was sent to 1618 postresidency fellows of the American Academy of Pediatrics.

RESULTS

The response rate was 68%. More than 90% of pediatricians said that they should examine their patients' teeth for caries and educate families about preventive oral health. However, in practice, only 54% of pediatricians reported examining the teeth of more than half of their 0-3-year-old patients. Four percent of pediatricians regularly apply fluoride varnish. The most common barrier to participation in oral health-related activities in their practices was lack of training, which was cited by 41%. Less than 25% of pediatricians had received oral health education in medical school, residency, or continuing education. Most pediatricians (74%) reported that availability of dentists who accept Medicaid posed a moderate to severe barrier for 0-3-year-old Medicaid-insured patients to obtain dental care.

CONCLUSIONS

Pediatricians see it within their purview to educate families about preventive oral health and to assess for dental caries. However, many pediatricians reported barriers to fully implementing preventive oral health activities into their practices. Pediatricians and dentists need to work together to improve the quality of preventive oral health care available to all young children.

Dental care and children with special health care needs: a population-based perspective

This paper grew out of a project reviewing progress in children's oral health after Oral Health in America: A Report of the Surgeon General was published in 2000. It includes a summary of advances in national surveillance of children with special health care needs (CSHCN), and presents more recent data on unmet dental care need among CSHCN. To that end, we used the 2006 National Survey of Children with Special Health Care Needs to determine the prevalence of unmet dental care need among CSHCN and to compare this within subgroups of CSHCN, as well as to children without special health care needs, and to results from the previous iteration of this survey. Dental care remains the most frequently cited unmet health need for CSHCN. More CSHCN had unmet needs for nonpreventive than preventive dental care. CSHCN who are teens, poorer, uninsured, had insurance lapses, or are more severely affected by their condition had higher adjusted odds of unmet dental care needs. CSHCN who were both low income and severely affected had 13.4 times the adjusted odds of unmet dental care need. In summary, CSHCN are more likely to be insured and to receive preventive dental care at equal or higher rates than children without special health care needs. Nevertheless, CSHCN, particularly lower income and severely affected, are more likely to report unmet dental care need compared with unaffected children. Despite advances in knowledge about dental care among CSHCN, unanswered questions remain. Recommendations are provided toward obtaining additional data and facilitating dental care access for this vulnerable population.

Preventive dental care for young, Medicaid-insured children in Washington state

BACKGROUND

Children from low-income families face barriers to preventive dental care (PDC) and are disproportionately affected by dental caries. The Access to the Baby and Childhood Dentistry (ABCD) program of Washington State is targeted to Medicaid-insured children <6 years of age to improve their access to PDC.

OBJECTIVES

To test the hypothesis that residing in an ABCD county improves the likelihood of receiving PDC and, to compare PDC use among young, Medicaid-insured children in Washington to national statistics.

METHODS

We extracted 2003 Washington Medicaid dental claims for continuously enrolled children <or=6 years of age. Multivariable analysis was performed to identify variables independently associated with >or=1 preventive dental visit (PDV) in 2003. For national comparison, we used the 2003 Medical Expenditure Panel Survey (MEPS).

RESULTS

Among Medicaid-insured children <or=6 yrs of age from WA counties with ABCD program, 45% had at least 1 PDV compared with 36% from non-ABCD counties (P < .001) and 37% of US children with continuous private insurance (P < .001). There were significantly higher adjusted odds of a PDV for children from ABCD counties relative to non-ABCD counties (odds ratio: 1.30 [95% confidence interval: 1.05-1.60]).

CONCLUSIONS

We confirmed our hypothesis that residing in an ABCD county was associated with a higher likelihood of having >or=1 PDV in 2003. We also found that significantly more children in established ABCD counties received PDC compared with privately insured US children. These findings provide additional evidence that the ABCD program reduces disparities in dental care access among young, Medicaid-insured children in Washington and point to the importance of expanding the ABCD program to other states.

Perceptions of oral health training and attitudes toward performing oral health screenings among graduating pediatric residents

BACKGROUND

There is a lack of access to oral health services for American children. Some propose that pediatricians be trained to deliver preventive screening and education to families until they access a dental home. However, little is known about the current oral health training provided during pediatric residency. OBJECTIVE. The purpose of this work was to evaluate the oral health training that pediatricians receive during residency and their attitudes toward performing basic oral health screenings.

METHODS

The American Academy of Pediatrics Survey of Graduating Residents is an annual, randomly sampled national survey of graduating pediatric residents. The 2006 Survey of Graduating Residents surveyed 611 residents and examined their perception of their oral health training and their attitudes about performing oral health screenings.

RESULTS

Thirty-five percent of residents received no oral health training during residency. Of those who did, 73% had <3 hours of training, and only 14% had clinical observation time with a dentist. Seventy-one percent felt that they had too little oral health training, and only 21% felt that their residency was very good or excellent in preparing them to perform oral health-risk assessments. Residents felt confident in their ability to offer anticipatory guidance but not to do the more technical oral health screenings. The majority of residents believed that pediatricians should conduct basic oral health screenings. Multiple regression analysis indicated that residents who received >or=3 hours of oral health training, who applied for jobs in the inner city, and whose career goal was to work in primary practice are those most likely to support this idea.

CONCLUSIONS

Pediatric residents currently receive little training in oral health, and the majority wish for more. This study shows that oral health training during residency can increase pediatrician confidence in participating in important oral health promotion tasks, including anticipatory guidance, oral screenings, and oral health-risk assessment.

Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country

OBJECTIVE

To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua.

MATERIAL AND METHODS

A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression.

RESULTS

The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs.

CONCLUSION

Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.

Health insurance and access to health care in the United States

Health insurance, poverty, and health are all interconnected in the United States. This article synthesizes a large and compelling body of health services research, finding a strong association between health insurance coverage and access to primary and preventive care, the treatment of acute and traumatic conditions, and the medical management of chronic illness. Moreover, by improving access to care, health insurance coverage is also fundamentally important to better health care and health outcomes. Research connects being uninsured with adverse health outcomes, including declines in health and function, preventable health problems, severe disease at the time of diagnosis, and premature mortality.