Dental Care and Children with Special Health Care Needs: A Population-Based Perspective

Department of Pediatrics, Division of General Pediatrics, University of Washington, Seattle, Washington 98195, USA.
Academic pediatrics (Impact Factor: 2.01). 11/2009; 9(6):420-6. DOI: 10.1016/j.acap.2009.09.005
Source: PubMed


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.

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Available from: Charlotte Lewis, Apr 28, 2015
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    • "Unmet dental care needs tend to be more prevalent in the CSHCN population compared to the general population of children (Lewis, 2009; Szilagyi et al., 2003). CSHCN have chronic physical, developmental, behavioral, or emotional conditions which require health care and related services of a type or amount beyond that required by children in general (Mayer et al., 2004). "
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    ABSTRACT: Objective: The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. Methods: Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. Results: Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. Conclusion: Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.
    Full-text · Article · Dec 2015
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    • "Dental care should be viewed as integral part of comprehensive health care program coordinated by the medical home (40). Based on the higher frequency of the regular medical screening of autistic children compared to scheduled dental visits (19), it can be presumed that an interdisciplinary approach with the child’s physician might help to overcome the anxiety of the dental appointment. "
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    ABSTRACT: Objectives: This article reviews the present literature on the issues encountered while coping with children with autistic spectrum disorder from the dental perspective. The autistic patient profile and external factors affecting the oral health status of this patient population are discussed upon the existing body of evidence. Material and Methods: The MEDLINE database was searched using the terms ‘Autistic Disorder’, ‘Behaviour Control/methods’, ‘Child’, ‘Dental care for disabled’, ‘Education’, ‘Oral Health’, and ‘Pediatric Dentistry’ to locate related articles published up to January 2013. Results: Most of the relevant studies indicate poor oral hygiene whereas they are inconclusive regarding the caries incidence in autistic individuals. Undergraduate dental education appears to determine the competence of dental professionals to treat developmentally disabled children and account partly for compromised access to dental care. Dental management of an autistic child requires in-depth understanding of the background of the autism and available behavioural guidance theories. The dental professional should be flexible to modify the treatment approach according to the individual patient needs. Key words:Autism spectrum disorder, dental management, children.
    Full-text · Article · Aug 2013 · Medicina oral, patologia oral y cirugia bucal
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    • "With the exception of MPS IV patients, there was considerable heterogeneity in the prevalence of predisposing dental anomalies and poor hygiene and in the incidence of decay and gingivitis between and within classes of MPS. Therefore, given the serious challenges in providing dental treatments, and considering the evidence from the literature about increased oral health needs in vulnerable groups of patients (Lewis 2009; Shaw et al. 1986; Purohit et al. 2010) the authors recommend that dental professionals should consider all patients with an MPS disorder as being at highrisk of dental disease. Failure by parents and carers to access dental care needs to be addressed. "
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    ABSTRACT: Background: As one of the 4 United Kingdom national centres for Lysosomal Storage Disorders, Birmingham Children's Hospital (BCH) cares for 49 patients with a mucopolysaccharide (MPS) disorder. Presently, their oral health needs have never been fully investigated. Enzyme therapies are revolutionising medical treatment, and will prolong life expectancy. Therefore, oral health and its impact on quality of life are increasingly important. Hypothesis: Patients with an MPS disorder have greater oral health needs in comparison with the general population. Design: Forty-six patients with an MPS disorder were investigated for caries, gingival health and enamel opacities. Questionnaires to establish the utilisation of dental services and assess the perceived difficulties in achieving adequate oral health care were completed. Results: Patients with an MPS disorder have specific oral health needs depending on the type of MPS experienced. This study found 76% of patients with MPS IV had experienced dental caries and they all showed evidence of a generalised unspecified enamel defect. Subjects with MPS I, II and III did not have an increased caries rate; 50% of the study group had received dental treatment in the past, of which 74% (17, n = 23) required a general anaesthetic. Conclusion: The MPS disorders can have a significant effect on the developing dentition. Subjects with MPS IV do have an increased oral health need in comparison with the general population and the other MPS groups due to their increased caries rate and enamel defects. Further research is required to fully assess their needs and investigate any structural tooth defects.
    Full-text · Article · Jan 2012
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