Elsevier

Academic Pediatrics

Volume 9, Issue 6, November–December 2009, Pages 415-419
Academic Pediatrics

Access and Barriers to Care
Update on Disparities in Oral Health and Access to Dental Care for America's Children

https://doi.org/10.1016/j.acap.2009.09.010Get rights and content

This contribution updates federal survey findings on children's oral health and dental care since release of Oral Health in America: A Report of the Surgeon General in 2000. Dental caries experience continued at high levels, impacting 40% of all children aged 2 to 11 years, with greater disease and untreated disease burden borne by poor and low-income children and racial/ethnic minorities. Caries rates increased for young children (to 28% of 2- to 5-year-olds in the period 1999–2004) and remained flat for most other ages. The total volume of caries and untreated caries increased as the numbers of children increased. The proportion of US children with a dental visit increased modestly (from 42% to 45% between 1996 and 2004), with the greatest increases occurring among children newly covered by the State Children's Health Insurance Program (SCHIP).

Disparities in dental visits continued to be evidenced by age, family income, race/ethnicity, and caregiver education. Parental reports of children's oral health and dental care parallel these findings and also reveal higher unmet dental needs among children with special health care needs. Racial- and income-based disparities in both oral health and dental care continue into adolescence and young adulthood. These disparities can, as in the past, be expected to exacerbate under the forces of growing income disparities and demographic trends.

Section snippets

Trends in Dental Caries among US Children

Dental caries experience in the primary teeth of children aged 2 to 5 years increased significantly and trended upward in children aged 6 to 11 years between the baseline period 1988 to 1994 that was reported in Oral Health in America and the period 1999 to 2004 (Table), whereas caries in permanent teeth of older children decreased.5 Overall, 42.2% of US children aged 2 to 11 years experienced tooth decay, and more than a quarter of 2- to 6-year-olds were affected. For purposes of anticipating

Trends in Dental Service Utilization among US Children

The most comprehensive and definitive national estimates of dental utilization by children are those derived from the federal Medical Expenditure Panel Survey, which tracks a panel of families over time to determine aspects of their health care utilization.9 Between 1996 and 2004, the percentage of children under 21 years with at least 1 dental visit increased from 42% to 45%, with highest utilization rates and greatest increases for 6- to 12-year-olds. Visits for children under age 6 increased

Parental Reports of Oral Health and Dental Care

Parental reports of both oral health and dental care reflect this range of documented disparities. Stepwise disparities in perceived oral health status by race and income parallel findings from the CDC National Health and Nutrition Examination Survey (NHANES) survey.12 Although 76% of white parents report that their children's “teeth are in excellent or very good condition,” only 61% of black parents and 47% of Hispanic parents report this positive health status. Similarly, only 49% of poor

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