Tooth decay is a common and preventable dental condition among children. Although 90% of all dental cavities are preventable, 50% of children in Pennsylvania experience tooth decay by age 15. Good oral hygiene and regular dental care are keys to reducing cavities, and the American Academy of Pediatric Dentistry (AAPD) recommends that children receive at least two dental check-ups every year.

According to the AAPD, dental conditions cause children in the United States to miss more than 750,000 school days each year while millions of school hours are lost to dental-related illness. Minimizing absences from school is one of many important reasons for assuring that children maintain good oral health.

Using data from the Southeastern Pennsylvania (SEPA) 2006 Household Health Survey, this article examines use of dental care among children 4-17 years of age. Child proxies (adult survey participants most informed about the selected child’s health care) were asked if the child was examined or treated by a dentist in the past year and about the primary reason for not visiting a dentist. They were also asked if there were any occasions in the past year where the child needed dental care but did not receive it due to cost. Finally, this article presents data trends to identify progress and areas for improvement in children’s dental care.

DENTAL VISITS
 
In 2006, 87.9% of children aged 4 to 17 were examined or treated by a dentist in the past year. However, 12.1% or about 88,700 children in SEPA did not receive a dental exam. When asked why the child had not seen a dentist in the past year, approximately one out of five (22.9%) responded that the child did not need a dental exam. Hence, efforts to educate parents and caregivers about the importance of preventive dental care visits may be necessary.

- Older children aged 15-17 years (86.5%) were least likely to have received a dental exam in the past year, compared to younger children aged 4 to 10 (88.0%) and children aged 11-14 years (89.0%).

- In SEPA, girls and boys were almost equally likely to have had a dental exam in the past year (88.4% vs. 87.4%).

- A lower proportion of children in Philadelphia (81.8%) received a dental exam in the past year, as compared to Delaware (88.6%), Bucks (91.2%), Montgomery (92.7%), and Chester (94.5%) counties.

- White children (92.6%) were more likely than Black/African-American (80.6%) or Latino (80.0%) children to have had a dental exam in the last year.

- Compared to children who are uninsured (56.7%), insured children (89.2%) were more likely to have had a dental exam in the last year.

- Nonpoor children (89.9%) were more likely than poor children (77.0%) to have had a dental exam in the last year.

NO DENTAL CARE DUE TO COST

Dental conditions can get worse if treatment is delayed, possibly causing the child discomfort or incurring higher dental expenses. In 2006, 6.9% of children needed dental care at some point in the past year but did not receive it due to cost. This percentage represents approximately 50,500 children in SEPA who postpone dental care on at least one occasion because of cost considerations. In addition:

- Children aged 11 to 17 years (8.6%) were more likely than younger children aged 4 to 10 (4.7%) to not get the dental care they needed due to cost.

- Latino children (14.7%) were more likely than Black (9.8%) or White (4.1%) children to not get the dental care they needed as a result of cost.

TRENDS OVER TIME

Beginning in 1998, there has been a steady decline in the percentage of children aged 4 and older who have not received a dental exam in the past year (see Figure 1). In other words, SEPA has made progress in increasing the percentage of children who use the oral health care system each year. Although more children are now receiving routine dental care, the percentage of children who needed dental care but did not receive it due to cost has increased from 5.4% (2002) to 6.9% (2006) (see Figure 2).

In conclusion, data from the 2006 Household Health Survey indicate that children who are poor and uninsured are less likely to have received a dental exam in the past year. Trend data suggest that in recent years, there is an increasing proportion of children who needed dental care but had to delay or forgo seeking dental care on at least one occasion due to cost considerations. Clearly, there remains room for improvement with regard to improving the utility and affordability of oral health services among children. In Pennsylvania, there are dental clinics that provide free or reduced-fee services to eligible patients. For a listing of free/reduced fee dental clinics by county, please visit the Pennsylvania Dental Association website (www.padental.org).

For more information on the findings presented in this article, please contact Community Health Data Base staff member Allegra Gordon, agordon@phmc.org.