Changes in Children's Oral Health Status and Receipt of Preventive Dental Visits

United States, 2003-2011/2012

Mahua Mandal, MPH, PhD; Burton L. Edelstein, DDS, MPH; Sai Ma, PhD; Cynthia S. Minkovitz, MD, MPP

Disclosures

Prev Chronic Dis. 2013;10 

In This Article

Results

Oral Health Status and Preventive Dental Visit and Child and Family Characteristics, 2011/2012

In unadjusted analyses, having excellent or very good oral health status and at least 1 preventive dental visit in the past 12 months in 2011/2012 was associated with children who were white, had health insurance, had excellent or very good health status, had never moved, lived in families that spoke primarily English, lived with an adult who graduated high school, and lived in families whose income exceeded the FPL. Additionally, children had higher odds of having excellent or very good oral health status if they were aged 1 to 2 years (compared with being aged 3–17 years); female; lived with no other children or 1 other child; and lived with 2 adults. In contrast, children had higher odds of having at least 1 preventive visit if they were older and lived with other children.

Except for children who had never moved, individual characteristics associated with excellent or very good oral health status in the unadjusted analysis remained significant in adjusted analysis (Table 1). Moving fewer than 5 times was associated with excellent or very good oral health status. Family characteristics associated with more favorable oral health status included living with an adult who had more than high school education and having an income more than 200% above the FPL. There were some differences between the adjusted and unadjusted associations for children receiving at least 1 preventive dental visit. Only Hispanic children were less likely than white children to receive at least 1 preventive dental visit, as were children who moved 5 times or more. Similar to the adjusted associations for oral health status, children were more likely to have a preventive dental visit if they lived with someone who had more than high school education and in a household with an income more than 200% above the FPL. Additionally, children who lived with other children were more likely to have had a preventive dental visit.

Adjusted Prevalence of Oral Health Status and Preventive Dental Care Between 2003 and 2011/2012

The adjusted prevalence of children's oral health status reported as excellent or very good significantly increased in the United States, from 67.7% in 2003 to 71.9% in 2011/2012 (P < .001). Although prevalence of excellent or very good oral health status did not increase among children without health insurance, it did increase among children with public health insurance (55.6% to 59.4%, P < .001) and private health insurance (76.4% to 81.1%, P < .001). Favorable oral health status increased for children at all household poverty levels. The prevalence of children with excellent or very good oral health status living at or below the FPL increased from 48.9% to 52.4% (P = .001) and for those living more than 400% above the FPL, it increased from 82.5% to 86.3% (P < .001).

Significant improvements in parent reports of children's oral health status were observed among 26 states (Table 2). Parents in Utah reported the most improvement (69.1% to 79.2%, P < .001), and those in Missouri reported the least improvement that was significant (71.4% to 75.0%, P < .001).

The adjusted prevalence of children who received at least 1 preventive dental visit in the past 12 months also significantly increased in the United States, from 71.5% in 2003 to 77.0% in 2011/2012 (P < .001). This outcome improved among children with no health insurance (50.3% to 54.1%, P = .028), public health insurance (from 64.6% to 73.3%, P < .001), and private health insurance (from 78.0% to 81.9%, P < .001). Similar to reported improvements in oral health status, the prevalence of children who received at least 1 recent preventive dental visit increased at all household poverty levels (≤100% FPL, from 58.2% to 68.3%, P < .001; >400% FPL, from 82.3% to 85.0%, P < .001).

Parents in all but 6 states (Alaska, Florida, Minnesota, North Dakota, Wisconsin, and Wyoming) reported significant improvements in children receiving at least 1 preventive visit. District of Columbia had the most improvement (from 70.0% to 82.7%, P < .001) and Kentucky had the least among states with significant change (from 72.4% to 75.8%, P < .016).

Adjusted Odds of Oral Health Status and Preventive Dental Care, 2003 and 2011/2012

Compared with Nevada, where parents reported the worst pediatric oral health status, 39 states had higher odds of children having excellent or very good oral health in 2003 (Table 3). In the same year, parents in Maine had the highest odds of reporting positive oral health status (adjusted odds ratio [AOR], 1.74; 95% confidence interval [CI], 1.44–2.11). In 2011/2012, parents in only 19 states had higher odds of reporting excellent or very good oral health status compared with Nevada, with Vermont having the highest odds (AOR, 1.71; 95% CI, 1.31– 2.23). Compared with Nevada, in 2003, 39 states had higher odds of children receiving recent preventive dental care, and Vermont had the highest odds (AOR, 2.62; 95% CI, 2.11–3.25). In 2011/2012, all but 7 states (Alaska, California, Florida, Minnesota, Missouri, and North Dakota) had higher odds of children receiving preventive dental care, with Washington having the highest odds (AOR, 3.22; 95% CI, 2.35–4.41).

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