Dissatisfaction with dental care among mothers of Medicaid-enrolled children

Objectives: This paper is part of a larger study examining the impact of mothers’ having a regular source of dental care (RSDC) on utilization of dental care and oral health of their preschool children. We describe levels of satisfaction with care among mothers whose preschool children were enrolled in Medicaid in Washington State. We report mothers’ satisfaction related to having a RSDC by type of dental setting/office. Methods: Disproportionate stratified sampling by racial/ethnic group selected 11 305 children aged 3–6 in Medicaid in Washington State. Mothers (n = 4373) completed a mixed‐mode survey. Satisfaction with dental care was measured using the Dental Satisfaction Questionnaire (DSQ). Results: Overall mean DSQ was 57.1 ± 9.9 (range 18–89). A higher score indicates greater satisfaction. There was not evidence of a difference in dissatisfaction by race/ethnicity but Blacks and Hispanics were less satisfied with pain management than Whites. The majority of respondents agreed with the statement that ‘Dentists sometimes act rude to their patients.’ Satisfaction is higher for mothers who have a regular private dentist they see consistently versus having a regular dentist through a public or non‐profit clinic. Conclusions: The satisfaction with dental care for this population is low, and considerably lower than found in other studies for primary medical care. Steps need to be taken to increase dental satisfaction and access to private dental clinics, and to increase perceived quality and pain management of dental care in both private clinics and public/non‐profits serving low‐income populations.     

An examination of racial/ethnic disparities in children's oral health in the United States

Objective: To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care. Methods: Data were from the 2007 National Survey of Children's Health, for children 2‐17 years (n = 82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model‐based survey‐data‐analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors. Results: Unadjusted results show large racial/ethnic oral health disparities. Compared with non‐Hispanic White people, Hispanic and non‐Hispanic‐Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0‐4.6), 2.2 (2.0‐2.4), respectively], lack preventive care [ORs 1.9 (1.8‐2.0), 1.4 (1.3‐1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3‐1.7), 1.4 (1.3‐1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non‐Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5‐1.8) and 1.2 (1.1‐1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9‐1.1), 1.1 (1.1‐1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non‐Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6‐0.7)]. Conclusions: Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.     

Nursing caries and buying time: an emerging theory of prolonged bottle feeding

Abstract – Background: Nursing caries is considered to be problematic by dental health professionals. In their zealousness to solve the nursing caries problem dental health professionals forgot to ask the question: ‘Why do mothers persist in prolonged bottle feeding?’ Aim: To use grounded theory procedures and techniques to analyse the qualitative data obtained from mothers and to generate an emerging theory of prolonged bottle feeding. Method: A series of individual in‐depth interviews were conducted with 34 mothers of children with nursing caries. The children were aged between 3 and 4 years. Data were analysed using the grounded theory procedures and techniques of open and selective coding. Results: The core category or the mothers’ main concern that emerged from the data was conceptualized as ‘buying time’. The feeding bottle bought time away from crying children by silencing them but also bought extra time with the child. Therefore, two different behavioural styles or categories of buying time emerged. These were: (i) to buy time away from the demands of their crying toddlers (instant solutions) and (ii) to buy extra time with their ‘toddler‐babies’ (double‐binding). The feeding bottle acted as an ‘instant solution’ as on seeing the bottle the child would instantly ‘stop crying’ and peace would reign. Double‐binding described how the feeding bottle was used to buy extra time for ‘babyhood closeness’ between mother and child while exposing the mothers’ harsh rejecting behaviours. Discussion: An understanding of the time concerns that the mothers experienced when caring for their young children and how they resolve them provides an important insight into the reasons for prolonged bottle feeding.     

The association between low-socioeconomic status mother's Sense of Coherence and their child's utilization of dental care

da Silva AN, Mendonça MH, Vettore MV. The association between low‐socioeconomic status mother’s Sense of Coherence and their child’s utilization of dental care. Community Dent Oral Epidemiol 2011; 39: 115–126. © 2010 John Wiley & Sons A/S Abstract – Objectives: The objective of this study was to investigate the relationship of low‐socioeconomic status mother’s Sense of Coherence (SOC) and their child’s utilization of dental care services in a city of Southeast Brazil. Methods: A cross‐sectional study was conducted on a sample of 190 schoolchildren aged 11–12 and their mothers in Sao João de Meriti‐RJ, Southeast Brazil. The outcome variables were children’s use of dental care services and visiting dentists mainly for check‐ups. Demographic and socioeconomic characteristics and data regarding children’s dental care use were collected through interviews with mothers. Children’s oral health‐related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mother’s SOC was assessed through the validated short version (13‐item) of Antonovsky’s scale. Multiple logistic regression was used in the data analysis. Results: Of the mothers, 81.1% reported on their child’s utilization of dental care services. Of them, 42.9% considered check‐ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR = 2.08 95%CI = 1.17–3.64) and visit a dentist mainly for check‐ups (except for dental treatment) (OR = 2.02 95%CI = 1.06–3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, children’s oral health‐related behaviours and oral health measures. Conclusions: Mother’s SOC was a psychosocial factor associated with their child’s pattern of use of dental care services in low‐socioeconomic status families.     

Psychosocial factors and early childhood caries among low-income African-American children in Detroit

Objectives: This study sought to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, behaviors, and psychosocial factors relate to young children's early childhood caries (ECC) status in a lower‐income African–American population. Methods: Data were collected by the Detroit Dental Health Project (NIDCR grant), a population‐based study of 1021 African–American families with at least one child under 6 years of age and living in 39 low‐income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1–5 years and their biological mothers, and conducted in SUDAAN to account for the complex sampling design. Survey data included health belief scales on mothers’ self‐efficacy, feelings of fatalism, knowledge about appropriate bottle use and children's oral hygiene needs, brushing habits, psychosocial measures of depressive symptoms (CES‐D), parenting stress, and availability of instrumental social support. The child's age, dental insurance status, dental visit history, and 1‐week brushing frequency were also included in the model. Children's ECC status, based on a dental examination, was the main outcome. The dental team used the International Caries Detection and Assessment System (ICDAS) criteria for caries detection. Each child was classified as either caries‐free or having ECC or severe ECC (S‐ECC) based on the case definition of ECC proposed by an expert panel for research purposes with preschool‐aged children. Results: The dental team followed a specific examination protocol and established reliable and consistent ratings of ECC based on the ICDAS criteria. The inter‐rater reliability kappa was 0.83 overall, and the intra‐rater reliability kappa was 0.74 overall. One‐third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children's hygiene needs were associated with ECC among preschool‐aged children. ECC was higher among younger children who had past restorative care. Conclusions: These findings call attention to the high prevalence of ECC in this population and the need to consider psychosocial as well as traditional risk factors in developing interventions to reduce oral health disparities.     

Oral health among white, black, and Mexican-American elders: an examination of edentulism and dental caries

Objectives: To examine racial/ethnic disparities in oral health among older Americans. Methods: Differences in frequency of edentulism and number of decayed, missing, and filled teeth were assessed in 2,679 non‐Hispanic white, 742 non‐Hispanic black, and 934 Mexican‐American individuals aged 60 and older from the National Health and Nutrition Examination Survey (1999‐2004). Results: Controlling for potential confounding variables, blacks and Mexican‐Americans had significantly higher numbers of decayed teeth but fewer numbers of filled teeth than whites. Although blacks had a lower likelihood of being edentulous than whites, dentate blacks had a higher number of missing teeth. Compared with whites, Mexican‐Americans were less likely to be edentulous, and dentate Mexican‐Americans had fewer missing teeth. Our study also showed that blacks and Mexican‐Americans had less frequent dental checkups than whites. Conclusions: Oral health disparities are persistent across racial/ethnic groups for older Americans despite the fact that the differences between groups typically diminish when socioeconomic, health‐related, and behavioral factors are considered in the models. Our study suggests that reducing racial/ethnic oral health disparities requires multiple clinical approaches.     

Child dental expenditures: 1996

PURPOSE: Because little has been reported about child dental expenditures, federal data were used to estimate dental care expenditures for U.S. children by age, sex, ethnic/ racial background, family income, parental education and parental employment. METHODS: Parentally reported data on dental expenditures and sources of expenditures were extracted from the most recent available federal healthcare expenditures studies, the 1996 federal Medical Expenditure Panel Survey (MEPS). Using the survey's large sample and complex design, these data represent the entire U.S. child population. RESULTS: Nearly 12 billion dollars were expended for children's dental care averaging $375 per child who obtained care. Overall sources of payment were 47% out of pocket, 45% insurance and 8% "other" including primarily Medicaid. Disproportionately litde spending was made on behalf of low-income and minority children despite their higher disease experience. The proportion of spending that was paid out of pocket was high for all groups of children including those eligible for Medicaid even though Medicaid prohibits cost sharing. CONCLUSIONS: Dental care for children accounts for approximately one-quarter of U.S. dental spending and is a major component of child health care costs. Income and racial disparities in expenditures favor higher income children despite Medicaid coverage for lower income children. High levels of reported out-of-pocket costs for Medicaid eligible children suggest that Medicaid fails to meet families' needs in obtaining care. Meeting the oral health needs of poor children will require considerably greater expenditures, particularly through improved Medicaid financing and administration.     

Use of preschool dental services in a New Zealand birth cohort

Abstract The utilisation of preschool dental services was examined prospectively in a birth cohort of New Zealand 4-year-old children. There were highly significant associations between non-utilisation of dental care services and a series of measures of family social background and the quality of care provided to the child. Factors associated with increased risks of non-utilisation of dental services included: mother of non-European ethnic origin; low gross family income; single parent family; non-attendance at preschool education facilities; failure to attend community nurse services and a lower utilisation of routine child health care services including immunisations and routine postnatal checks. The implications of the non-utilisation of preschool dental care are discussed in the context of the more general problem of providing an adequate and equitable standard of health care for children.     

Dental caries in preschool Beijing and Connecticut children as described by a new caries analysis system

Abstract – A total of 625 children, 3-4 yr old, 426 from Connecticut Head Start programs and 199 from Beijing area nursery schools, were clinically examined for dental caries. Results were analyzed using the traditional dmfs index as well as a new "Caries Analysis System". This new system differentiated between caries patterns and examined the percentage of affected children (Prevalence), the degree to which these children were affected (Severity) and the proportion of total caries each disease pattern represented (Distribution). The Caries Analysis System revealed differences in caries experience and patterns among the racial/ethnic groups that the dmfs index did not. The Beijing children experienced the greatest Prevalence of all caries patterns; however, the Severity and Distribution of the caries patterns were similar to those of the Connecticut children. Within the group of Connecticut children, White children had the lowest Prevalence but the greatest Severity when compared with the Black and Hispanic children.     

Pediatric dental visits during 1996: an analysis of the federal Medical Expenditure Panel Survey

Pediatric health policy articulated by the government, health professions, and child advocates is concerned with eliminating health disparities among children and increasing access to essential pediatric health services. National data are widely available on dental health status and associated disparities by income and race, but little data have been reported on dental service utilization by children. Data from the 1996 federal Medical Expenditure Panel Survey were analyzed to determine the percentage of children who obtained a dental visit and the number of visits children experienced by age, sex, ethnic/racial background, family income, and parental education. Overall, 43% of all children ages birth through 18 obtained at least one dental visit in 1996. Among children who see a dentist, the average number of visits during 1996 was 2.7. Low income, low education, and minority status are all associated with both lower odds of having a dental visit and lower number of visits per utilizer. Children under 6 had less than half the dental visit rate of older children and had fewer visits per person among utilizers.     

Association between a child’s caries experience and the mother’s perception of her child’s oral health status

BackgroundMothers play a primary role in the health of their children. This role may be of particular importance for children in Appalachia who have increased caries relative to children in other regions of the United States. The authors examined the degree to which a child’s caries experience was in concordance with the mother’s perception of the health of her child’s teeth, and how concordance varied by sociodemographic factors.MethodsThe authors obtained cross-sectional data on mother-child dyads with children younger than 6 years through the Center for Oral Health Research in Appalachia study. They interviewed and clinically examined a community-based sample of 815 mother-child dyads from Pennsylvania and West Virginia. They used an unadjusted zero-inflated negative binomial model to estimate the association between a mother’s perception of her child’s oral health status and her child’s caries. The authors compared sociodemographic factors between concordant and nonconcordant mother-child dyads using χ² tests.ResultsThe mother’s perception of her child’s oral health status was associated with the child’s caries experience (P < .001). Two-thirds of mother-child dyads showed concordance between the mother’s perception of her child’s oral health status and the child’s caries experience (n = 522, 64%). Concordance was associated with younger child age and the child having dental insurance (P < .01).Conclusions and Practical ImplicationsOn average, mothers accurately perceived their child’s caries experience. This accuracy was higher for younger children and children with dental insurance. The mother’s awareness of her child’s oral health status could be used to develop effective prevention and treatment strategies, particularly for young children vulnerable to caries.     

Socioeconomic and clinical factors associated with caregivers' perceptions of children's oral health in Brazil

Piovesan C, Marquezan M, Kramer PF, Bönecker M, Ardenghi TM. Socioeconomic and clinical factors associated with caregivers’ perceptions of children’s oral health in Brazil. Community Dent Oral Epidemiol 2011; 39: 260–267. © 2010 John Wiley & Sons A/S Abstract – Objectives: We assessed how socioeconomic and clinical conditions could affect parents’ perceptions of their child’s oral health. Methods: A cross‐sectional study was conducted in a sample of 455 children, aged 1–5 years, representative of Santa Maria, a southern city in Brazil. Participants were randomly selected among children attending a National Day of Children’s Vaccination. Clinical examinations provided information on the prevalence of caries, dental trauma, and occlusion. The caregivers’ perception of children’s oral health and socioeconomic status were assessed by means of a questionnaire. A Poisson regression model using robust variance (Prevalence ratio: PR; 95% CI, P ≤ 0.05) was performed to assess the association between the predictor variables and outcomes. Results: Parents were more likely to rate their child’s oral health as ‘poor’ if the former earned a lower income and the latter had anterior open bite and dental caries. Parents of black children with anterior open bite and dental caries were more likely to rate their child’s oral health as ‘worse than that of other children’. Conclusions: Clinical and socioeconomic characteristics are significantly associated with parents’ perceptions of their child’s oral health. Understanding the caregivers’ perceptions of children’s oral health and the factors affecting this could be useful in the planning of public health polices, in view of the inequity in the oral health pattern.     

Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age

Wigen TI, Espelid I, Skaare AB, Wang NJ. Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age. Community Dent Oral Epidemiol 2011; 39: 311–317. © 2010 John Wiley & Sons A/S Abstract – Objective: The purpose of the study was to explore associations between family status, family income, family size, mother’s age at child birth, mother’s education and parents’ national background and caries experience in 5‐year‐old children. Method: This study is based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and the Public Dental Services. A total of 1348 children were followed from pregnancy to the age of 5 years. Questionnaires were completed by mothers twice during pregnancy and when the children were 3 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years. Results: Caries experience in the 5‐year‐old children was low; 89% had no caries experience (d_3–5 mft = 0). In multiple logistic regression having one or both parents of non‐western origin (OR 3.4, CI 1.6–7.3), having had a change in family status from pregnancy to 5 years of age (OR 2.0, CI 1.1–3.4) and having mother with low education (OR 1.9, CI 1.3–2.8) were statistically significant risk indicators for having caries experience at the age of five. Conclusion: Family characteristics in pregnancy and early life were associated with caries experience in 5‐year‐old children. Primary care personnel meeting young children with one or several of these characteristics should consider referring the child to dental personnel to enable early initiation of health‐promoting activities.     

Racial/ethnic variations of practicing dentists

BACKGROUND: In recent years, the dental school population has changed from being predominantly white male to a more diverse racial and ethnic makeup. Noting this change in the student population, the American Dental Association undertook an in-depth study of the various racial/ethnic groups. METHODS: Questionnaires were sent to approximately 8,000 dentists nationwide. Samples were drawn for each of the following racial/ethnic groupings: white, black, Hispanic, Native American and Asian. The survey instrument asked questions about personal characteristics, work and private practice issues, household and practice income, and patient characteristics; it also asked for dentists' opinions. A final adjusted response rate of 57.0 percent was achieved. RESULTS: The majority of all dentists responded that they were "very satisfied" with their profession, but the survey found variations in patient mix, employment history and provision of free or discounted care. CONCLUSIONS: The survey examined dentists by race/ethnicity to identify differences and similarities. Cultural and ethnic minorities are the fastest growing segment of the U.S. population. As the profession becomes more diverse, practice patterns will affect the overall dental profession. PRACTICE IMPLICATIONS: Dentists' racial/ethnic backgrounds may change the provision of care as patient mix varies, with each dentist group treating a specific group of patients in regard to family income, racial/ethnic background and subgroups for whom they offer free or reduced-rate dental care.     

Association of maternal risk factors with early childhood caries in schoolchildren of Moradabad, India

International Journal of Paediatric Dentistry 2011 Background. Children who have caries in their primary teeth in infancy or toddlerhood tend to develop dental caries in their permanent dentition. Although risk indicators are helpful in identifying groups at risk, they give little information about the causes of difference in caries experience. Aim. To identify the association between maternal risk factors and early childhood caries among 3‐ to 5‐year‐old schoolchildren of Moradabad City, Uttar Pradesh, India. Design. A total of 150 child–mother pairs participated in the study. The maternal risk factors were assessed by a pretested questionnaire. After obtaining the consent, the mothers and their children were clinically examined for dental caries using Radike criteria (1968). Saliva was collected from all the participating mothers for assessing the Streptococcus mutans level. Results. Significant differences were found in mothers’ caries activity, high level of S. mutans, educational level, socioeconomic status, frequency of maternal sugar consumption, and their child’s caries experience (P < 0.001). Conclusions. Differences between children’s situations in these underlying factors play out as consequential disparities in both their health and the health care they receive.     

Racial/ethnic variations in associations between socioeconomic factors and tooth loss

Abstract – Objectives: To compare the associations between socioeconomic factors and tooth loss among White, Black, and Mexican‐American people. Methods: Analyses were conducted on 16 821 adults, using data from the National Health and Nutrition Examination Survey‐III. Age‐ and multivariate‐adjusted negative binomial regressions were used to explore the relation of socioeconomic factors, region of residence, gender, and foreign birth with the number of missing teeth. Effect modification by race/ethnicity was assessed by the inclusion of interaction terms. Results: In multivariate‐adjusted analyses, non‐Hispanic White people with 9–12 years of education exhibited 71% higher mean number of missing teeth than those with >12 years of education [incidence rate ratio (IRR) = 1.71, 95% confidence interval (CI): 1.52–1.92]. Education was unrelated to the number of teeth among non‐Hispanic Black people (IRR = 1.16; 95% CI: 1.00–1.35) or Mexican‐Americans (IRR = 1.10, 95% CI: 0.93–1.31). The poorest White people exhibited 39% more missing teeth, on average, than the most affluent White people, but no association between poverty and number of teeth was observed among Black or Mexican‐American people. Conclusions: The associations between socioeconomic factors and tooth loss vary across race/ethnicity. This suggests that the health benefits associated with high socioeconomic status are not equally shared across racial/ethnic groups.