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Published on: December 31, 2017
Differences in the Oral Health of Children With Medical Complexity
Kristina E Malik1, Sharon Scarbro2, Justin Yu3
1Department of Pediatrics (KE Malik and JA Feinstein), Adult and Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children's Hospital Colorado, Aurora, Colo.
Insights
Children with medical complexity face higher rates of poor oral health, with one in five experiencing dental issues. Medical complexity, not just socioeconomic factors, is linked to worse teeth conditions, highlighting a need for targeted dental care interventions.
Area of Science:
- Pediatric Health
- Oral Health
- Public Health
Background:
- Children with medical complexity (CMC) have serious conditions and disabilities, increasing their risk for poor oral health outcomes.
- Children with special health care needs (CSHCN) generally exhibit high rates of dental problems, including cavities.
- Oral health is integral to the overall well-being of CSHCN and CMC.
Purpose of the Study:
- To compare the oral health status between CMC and the broader CSHCN population.
- To identify disparities in oral health outcomes based on medical complexity.
- To inform strategies for improving dental care for vulnerable pediatric populations.
Main Methods:
- Cross-sectional analysis using the 2016-17 National Survey of Child Health data.
- Identification of CMC and CSHCN using validated algorithms.
- Comparison of oral health status and dental service utilization between groups, with multivariable logistic regression adjusting for covariates.
Main Results:
- CMC represented 6% of the CSHCN cohort (n=16,178).
- CMC had a significantly higher prevalence of fair/poor teeth conditions (19% vs 9%; P < 0.001).
- Adjusted analyses confirmed medical complexity as a predictor of fair/poor teeth conditions (aOR: 1.54; 95% CI: 1.01-2.34), though cavities and preventive service use did not differ significantly.
Conclusions:
- Despite high preventive dental service use, approximately 20% of CMC experience poor oral health.
- Medical complexity independently correlates with poorer dental conditions, even after accounting for socioeconomic factors.
- Further research into modifiable targets is crucial for optimizing dental care and health outcomes for CMC.
Objective:
Children with medical complexity (CMC), a subgroup of children with special health care needs (CSHCN) with the most serious medical conditions and disabilities, are at risk for negative effects from poor oral health. CSHCN have high rates of poor oral health, including cavities. This study aimed to compare oral health status between CMC and CSHCN.
Methods:
This was a cross-sectional analysis of the 2016-17 National Survey of Child Health data. CMC and CSHCN were identified using validated algorithms. The primary outcome was oral health status; secondary outcomes included dental service use. Bivariate analyses compared the prevalence and service use by medical complexity status. Multivariable logistic regression assessed oral health outcomes by complexity, adjusting for influencing variables.
Results:
Of 16,178 CSHCN ages 1 to 17 years, 6% were CMC and 94% were non-CMC CSHCN. Compared to CSHCN, CMC had a higher prevalence of fair/poor teeth conditions (19% vs 9%; P < 0.001) and higher odds for fair/poor teeth conditions after adjusting for socioeconomic factors (adjusted odds ratio [aOR]: 1.54; 95% confidence interval [CI]: 1.01-2.34). There was no statistically significant difference between groups when assessing cavities, toothache, or receipt of most preventive dental services.
Conclusions:
One in 5 CMC are reported by caregivers as having poor oral health, including cavities, despite high rates of receiving preventive dental services. After adjusting for socioeconomic factors, medical complexity remained associated with fair or poor teeth conditions. Understanding potentially modifiable targets could further help families of CMC prioritize dental needs and potentially reduce negative effects on overall health.
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