Children and Dental Care

There are many challenges with equitable access to dental care and these issues can have far-reaching effects. Challenges helping patients find access to dental care include limited insurance coverage and a reduced supply of dental teachers. Failure to address these issues can lead to a variety of medical issues as well as economic concerns.

Demographics play an enormous role in the question of children’s access to health care. In the article “Factors associated with use of preventative dental and health services among US adolescents,” the study observed that teenagers are least likely of all age groups to take advantage of preventative dental care (Yu, Bellamy, Schwalberg & Drum, 2001). Other factors associated with preventative dental care among teens included the level of income and access to insurance (Yu et al, 2001). The study concluded that immigrant teens were at the highest risk for inadequate preventative dental care (Yu et al, 2001). Other studies researched dental care among adolescents and found that teenagers who are lower on the economic scale did not spend as much as teenagers on the higher end of the economic scale (Paul, Wong, Galbraith & Hung, 2003). Adolescents who were tracked as they entered into adulthood to monitor the change in dental care reduced dental care as they became older (Okunseri, Okunseri, Garcia, Visotcky & Szabo, 2003). The findings concluded that whites and Asians were more likely to seek dental care while black and Hispanic teenagers were less likely (Okunseri et al, 2003). These studies point to a disparity in dental coverage based on demographics.

While some children are struggling to find dental insurance, there is a gap between those insured publicly versus those insured privately as well. The article “A National and State Profile of Leading Health Problems and Health Care Quality for US Children: Key insurance disparities and across-state variations” focuses on the disparity between private and public insurance and includes information on the effects of the Affordable Care Act (Bethell, Kogan, Strickland, Schor, Robertson, & Newacheck, 2011). The issue with ensuring equitable access to dental care is not limited to the United States. Reformers in England produced a study in the article “Provider incentives and access to dental care: Evaluating NHS reforms in England” that showed when insurers were moved from public insurance to private insurance, the amount of privately insured who sought dental care decreased (Whittaker & Birch, 2012). This also has implications for America’s Affordable Care Act.

Relationships between dentists and insurance companies can also have an impact on patient access to services. The article “Public Programs, insurance, and dental access” by Richard Manski blames part of the problem accessing dental programs on the adversarial relationship between insurance companies and dentists (2009). In addition, Manski’s research also supports the demographic factors associated with poor dental and again supports minority groups as having the lowest level of dental care (2009). Relationships between the dentist and client can also have a role in the desire of patients to seek out dental care.

In the article “Health care for children and youth in the United States: Annual report on patterns of coverage, utilization, quality, and expenditures by income,” the trend of limited access to dental services for low-income children continues. However, the article takes a more detailed look at minority groups who have insurance but choose not to seek dental care and lays part of the blame on the providers for not listening to the parents or showing the proper respect (Simpson, Owens, Zodet, Chevarley, Dougherty, Elixhauser & McCormick, 2005). In addition, low-income parents reported higher incidents of issues with specialist referrals (Simpson et al, 2005). This perception drives away the clients who are most in need of dental services. A more positive view of the dentist/patient relationship occurs in the article “Predictors of adolescent health care utilization” (Vingilisa, Wadeb & Seeleya, 2007). Researchers found that patients with high-risk behaviors were more likely seek out medical and dental assistance (Vingilisa et al, 2007). The conclusion of this article is that healthcare providers can also play an important role in the guidance of the patient in several lifestyle areas.

Another issue facing the dental community is the lack of faculty available to teach new dentists. This crisis in dental education is the subject of the article “Dental education’s role in improving children’s oral health and access to care” (Seale, McWhorter & Mouradian, 2009). Seale and company point out the deficit in qualified teachers for the aspiring dentists reduces the overall ratio of dentists to the population and also reduces the amount of time that a dentist can spend in learning a specialty like children’s dentistry (Seale et al, 2009). A reduction in qualified professionals will also serve to reduce access to dental care.

Adequate dental care affects more than just oral health and can affect overall medical health as well as have economic and educational effects. The focus of the article “How dental care can preserve and improve oral health” researches the importance of oral care in the overall scope of well-being and healthcare (Vargas & Arevalo, 2009). “Various studies have reported associations between oral health and systemic conditions. Studies assessing the link between coronary heart disease and periodontal diseases found that different presentations of periodontal diseases (gingivitis, tooth loss, periodontitis, and bone loss) were independent risk factors for coronary heart disease” (Vargas et al, 2009). The lack of available dental care has consequences in the economic realm as well. In the article “The Role of Non-Dental Health Professionals in Providing Access to Dental Care for Low- Income and Minority Patients,” Cohen discusses the impact of dental issues on missed work and school (2009). “In addition to causing pain and suffering, dental problems also affect economic productivity. Data from the 1996 NHIS revealed that adults missed approximately 2,442,000 days of work because of acute dental conditions, and it has been estimated that children who have oral health problems lose 52 million hours from school…” (Cohen, 2009). An increase in access to dental care will reduce the impact of economic and health concerns.

Early dental care is an important factor in reducing childhood tooth decay. Children who saw a dentist before the age of five were less likely to have dental issues in kindergarten (Beil, Rizier, Preisser, Stearns & Lee, 2013). The impact of this study showed that children who did not have access to dental care before the age of five would continue to have dental issues as they progressed (Beil et al, 2013). Another concern in the practice of dental medicine is the increase in sugary drinks and the effect on early childhood caries. The article “Preventing dental caries associated with sugar-sweetened beverages” researches the dramatic rise in sugar-sweetened drinks over the last 30 years and the impact on tooth decay (Marshall, 2013). Marshall’s research promotes better dental health and a call to action for dentists to include questions regarding the consumption of sugar-sweetened beverages as a regular part of the dental health assessment (2013). The connection between healthy eating and tooth decay is also the foundation of the article “The relationship between healthful eating practices and dental caries in children aged 2–5 years in the United States, 1988–1994” (Dye, Shenkin, Ogden, Marshall, Levy & Kanellis, 2004). While healthy eating limited tooth decay, there is no connection to a higher BMI and increased dental caries in children (Macek & Mitola, 2006). Early visits and healthy eating are the keys to early prevention of tooth decay.

Overall, there are many issues limiting access to dental services. Demographics and lack of insurance coverage and can reduce the ability of children to access adequate dental services. The effects of poor dental care can lead to economic and medical issues. Early access and healthy eating help prevent early tooth decay in children. Increased access to dental services is an important topic in dentistry today.

References

Beil, H., Rizier, R.G., Preisser J.S., Stearns, S.C., Lee, J.Y., (2013). Effects of Early Dental Office Visits on Dental Caries Experience. American Journal of Public Health, Published online ahead of print October 17, 2013, e1-e7.

Bethell, C.D., Kogan, M.D., Strickland, B.B., Schor, E.L., Robertson, J., Newacheck, P.W., (2011). A National and State Profile of Leading Health Problems and Health Care Quality for US Children: Key insurance disparities and across-state variations. Academic Pediatrics, 11 (3S), S22–S33.

Cohen, L.A., (2009). The Role of Non-Dental Health Professionals in Providing Access to Dental Care for Low- Income and Minority Patients. Dental Clinic North America, 53, 451–468.

Dye, B.A., Shenkin, J.D., Ogden, C.L., Marshall, T.A., Levy, S.M., Kanellis, M. J., (2004). The relationship between healthful eating practices and dental caries in children aged 2–5 years in the United States, 1988–1994. The Journal of the American Dental Association 135, 55-66.

Macek, M. D.; Mitola, D. J., (2006). Exploring the Association Between Overweight and Dental Caries Among US Children. Pediatric Dentistry, 28(4) 375-380.

Manski, R.J., (2009). Public Programs, insurance, and dental access. Dental Clinic North America, 53, 485–503.

Marshall, T.A., (2013). Preventing dental caries associated with sugar sweetened beverages. JADA, 144(10),1148-1152.

Okunseri, C., Okunseri, E., Garcia, R., Visotcky, M.S., Szabo, A., (2003). Predictors of dental care use: Findings from the national longitudinal study of adolescent health. Journal of Adolescent Health, 53, 663-670.

Paul, W.N., Wong, S.T., Galbraith, A.A., Hung, Y. (2003). Adolescent health care expenditures: A descriptive profile. Journal of Adolescent Health, 32S, 3-11.

Seale, N.S., McWhorter, A.G., Mouradian, W. E., (2009). Dental education’s role in improving children’s oral health and access to care. Academic Pediatrics, 9, 440–5.

Simpson, L., Owens, P.L., Zodet, M.W., Chevarley, F.M., Dougherty, D., Elixhauser, A., McCormick, M.C., (2005). Health care for children and youth in the united states: Annual report on patterns of coverage, utilization, quality, and expenditures by income. Ambulatory Pediatrics, 5, 6-44.

Vargas, C.M., Arevalo, O. (2009). How dental care can preserve and improve oral health. Dental Clinic North America, 53, 399–420.

Vingilisa, E., Wadeb, T., Seeleya, J., (2007). Predictors of adolescent health care utilization. Journal of Adolescence. 30, 773–800.

Whittaker, W.A., Birch, S., (2012). Provider incentives and access to dental care: Evaluating NHS reforms in England. Social Science & Medicine, 75, 2515-2521.

Yu, S., Bellamy, H., Schwalberg, R., Drum, A. (2001). Factors associated with use of preventive dental and health services among U.S. adolescents. Journal of Adolescent Health, 29, 395–405.