Unmet Dental Needs and Barriers to Care for Children with Significant Special Health Care Need
Authors: Nelson et al.
Pediatric Dentistry Vol 33 Jan/Feb 2011
Resident: Margaret Maclin
Purpose: The first known large scale survey of parents of children with special health care needs to determine their child’s: oral health status; access to dental care; perceived environmental and non environmental barriers; and oral health quality of life, accounting for each child’s medical diagnosis and severity of diagnosis.
Methods: A survey was written by 15 private dentists and the Massachusetts DPH task force on CSHCN which contained 72 questions. The survey contained items on medical diagnosis, description of condition, dental care status - including unmet needs, dental care access, dental care- emergency, general dentistry, pediatric dental specialty care, other specialty care, and hospitalization, dental care transition into adulthood, barriers to dental care; quality of life, background and demographics. The survery was translated into English and Spanish and sent to 3760 families containing children with SHCN.
- 1,128 surveys were completed.
- More than 90% of the children had seen a dentist within the past year.
- 66% saw a pediatric dentist.
- 21% needed intense behavioral intervention.
- Most families had high education, 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 due to medical conditions and more difficulty finding a dentist willing to provide care.
- Children with cystic fibrosis, metabolic disorders and hemophilia had the fewest barriers to care.
Assessment: Its important to note that there are sub pockets of CSHCN that are at higher risk for having unmet dental needs and not just CSHCN as a whole population. Significant influencing factor that was not addressed was diet with these particular children. And the difference between unmet dental needs: first time treatment versus unmet dental needs: recurrent decay or new cavitations.