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Unmet Dental Needs and Barriers to Care for Children with Significant Special Health Care Needs

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Purpose: The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis. Methods: A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts. Results: The study yielded 1,128 completed surveys. More than 90% of the children had seen a dentist within the past year; 66% saw a pediatric dentist, and 21% needed intense behavioral interventions. Although most families had high education levels, private dental insurance, and above average incomes, 20% of CSHCN had an unmet dental need. Children with craniofacial anomalies had twice as many unmet needs and children with cystic fibrosis had fewer unmet needs. Children with cerebral palsy, autism, developmental delay, and Down syndrome had more aversions to dental treatment, more treatment complications posed by their medical conditions, and more difficulty finding a dentist willing to provide care. Children with cystic fibrosis, metabolic disorders, or hemophilia encountered fewer barriers to care. Conclusions: The data paint a picture of high unmet dental needs with subpopulations of children with special health care needs who are more at risk for system barriers and internal family barriers to care based on their medical diagnoses.
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Keywords: ACCESS TO CARE; BARRIERS TO CARE; CHILDREN WITH SPECIAL HEALTH CARE NEEDS; ORAL HEALTH

Document Type: Research Article

Affiliations: 1: Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Mass, USA; Director of Postdoctoral Pediatric Dentistry, Department of Dentistry, Children's Hospital Boston, Boston, Mass, USA 2: University of Wisconsin Medical School, Madison, Wis, USA 3: Clinical Research Program, Children's Hospital Boston, USA 4: Pediatric Dentistry, Children's Hospital Boston/Harvard University, USA 5: Pediatric Dentistry, Ohio State University/Nationwide Children's Hospital, Colombus, Ohio, USA 6: Assistant Professor of Medicine and Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA 7: Candidate for an MPH, Harvard School of Public Health, USA 8: Assistant Professor of Pediatrics, Tufts University School of Medicine, Boston; Assistant professor of Pediatrics, Baystate Children's Hospital, Springfield, Mass, USA 9: Associate in Scientific Research, Division of General Pediatrics, Children's Hospital Boston; Instructor, Department of Pediatrics, Harvard Medical School, Boston, USA

Publication date: January 1, 2011

More about this publication?
  • Pediatric Dentistry is the official publication of the American Academy of Pediatric Dentistry, the American Board of Pediatric Dentistry and the College of Diplomates of the American Board of Pediatric Dentistry. It is published bi-monthly and is internationally recognized as the leading journal in the area of pediatric dentistry. The journal promotes the practice, education and research specifically related to the specialty of pediatric dentistry. This peer-reviewed journal features scientific articles, case reports and abstracts of current pediatric dental research.
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