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Hospital Dental Admissions and Caries Experience Among Children With Neurodevelopmental Disabilities: A
Philip J Schluter1,2, Nicholas Bowden3,4, Joanne Dacombe4
1Te Kaupeka Oranga, Faculty of Health, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, New Zealand.
Insights
Children with neurodevelopmental disabilities (NDDs) in New Zealand face significant oral health inequities, with higher rates of dental hospitalizations and caries. Targeted interventions are crucial to address this disparity.
Area of Science:
- Public Health
- Pediatric Dentistry
- Neurodevelopmental Disabilities
Background:
- Rising rates of severe childhood caries and dental hospitalizations in New Zealand.
- Existing oral health inequalities among children.
- Limited population-based data on oral health burden in children with neurodevelopmental disabilities (NDDs).
Purpose of the Study:
- To estimate and compare dental hospital admission rates in children with NDDs (attention-deficit hyperactivity disorder, autism, intellectual disability) compared to non-NDD peers.
- To analyze caries status at age 4 in children with and without NDDs.
- To assess the predictive accuracy of early screening for NDD-related oral health issues.
Main Methods:
- Utilized linked administrative databases for a near-national cohort of children aged ≤14 years (2011-2020).
- Employed Cox proportional hazard regression models to analyze dental hospital admissions, treating NDD as a time-varying covariate.
- Cross-sectionally examined caries status at 4-year-old screenings (B4 School Check).
Main Results:
- Children with any NDD indication had a 3.40 times higher hazard ratio for dental hospital admissions (95% CI: 3.22-3.60).
- Prevalence of visible caries at age 4 was higher in children with NDDs (17.6%) compared to those without (14.3%), but predictive accuracy was negligible (AUC=0.52).
- Overall, 3.8% of children had an NDD indication, and 8.9% experienced at least one dental hospitalization.
Conclusions:
- Children with NDDs in New Zealand experience significant oral health inequities.
- Targeted preventive strategies and adapted primary oral health services are essential for neurodiverse children.
- Early screening at B4SC lacks predictive capacity to effectively mitigate these oral health disparities.
Background:
Within Aotearoa | New Zealand, rates of largely preventable severe caries and dental hospitalisations among children are increasing and inequalities exist. However, little population-based empirical evidence exists describing this oral health burden among children with neurodevelopmental disabilities (NDDs). This study aimed to estimate and compare the rates of dental hospital admissions in a near-national population of children aged ≤ 14 years with attention-deficit hyperactivity disorder, autism, intellectual disability or any NDD after accounting for key confounding variables. Caries status for these children was derived from an oral health screening at 4 years and also examined.
Methods:
The cohort were children who had their B4 School Check (B4SC) national health screening assessment undertaken between 1 January 2011 and 31 December 2018 and followed until 1 January 2020 (the study end date). Linked administrative databases, which include NDD indication and dental hospital records, were utilised. Dental hospital admissions were assessed using unadjusted and adjusted Cox proportional hazard regression models treating NDD as a discrete time-varying covariate. Caries status at 4 years of age was investigated cross-sectionally and the area under the receiver operating characteristic curve used to assess predictive accuracy.
Results:
The eligible sample included 433 569 children (48.6% female) with a mean age of 9.3 years at the study end date. Overall, 16 359 (3.8%) children had at least one NDD indication and 38 574 (8.9%) had at least one dental hospitalisation. In adjusted analyses, the hazard ratio of dental hospitalisation admissions was 3.40 (95% CI: 3.22-3.60) for children indicated with any NDD compared to their non-NDD counterparts. At 4 years of age B4SC screening, 465 (17.6%) children out of 2640 indicated with any NDD had visible caries compared to 61 026 (14.3%) from 427 254 children without NDD indication (prevalence ratio = 1.24 [95% CI: 1.14-1.35]). However, the area under the receiver operating characteristic curve for this association was 0.52 (95% CI: 0.51-0.52), suggesting negligible predictive capacity.
Conclusion:
Children with NDDs in Aotearoa, New Zealand suffer from substantial oral health inequities. Targeted preventive strategies and adaptation to primary oral health services are needed to meet the needs of neurodiverse children and redress this substantial inequity. However, targeting children with NDDs at the B4SC is unlikely to mitigate these oral health inequities.
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