1 in 4 Californian children have never seen a dentist, study finds

Ω

Lack of dental care continues to be a significant problem for American children, who miss about 1.6 million school days each year due to dental disease.

A new study published in the July issue of the journal Health Affairs reveals that in California, nearly 25 percent of children have never seen a dentist and that disparities exist across race, ethnicity and type of insurance when it comes to the duration between dental care visits.

The study, "Racial and Ethnic Disparities in Dental Care for Publicly Insured Children," examines barriers to dental care among California children age 11 and under, using data from the 2005 California Health Interview Survey. The study contains data on nearly 11,000 children.

Researchers Nadereh Pourat, of the UCLA Center for Health Policy Research, and Len Finocchio, of the California HealthCare Foundation, found that Latino and African American children with all types of insurance were less likely than Asian American and white children to have visited the dentist in the previous six months — or even in their entire lifetime.

Similarly, researchers found that Latino and African American children in public insurance programs, including Medicaid and the Children's Health Insurance Program (CHIP), went to the dentist less often than white and Asian American children with the same insurance coverage. Overall, children with private insurance saw a dentist more often than those with Medicaid or CHIP.

"The findings suggest that having insurance isn't always enough," said Pourat, Ph.D., director of research planning at the UCLA Center for Health Policy Research. "We need to address the other barriers that keep children from getting the help they need."

The authors note the findings raise concerns about Medicaid's ability to address disparities in dental care access. Ultimately, they observe, more strategic efforts are necessary to overcome systemic barriers to care, including raising reimbursement rates paid to dentists who serve the Medicaid population and increasing the number of participating Medicaid providers.

"These findings indicate that many poor children in California do not make routine dental visits or simply never receive any dental care," said Finocchio, Dr.P.H., senior program officer at the California HealthCare Foundation. "Even with Medicaid coverage, there are tremendous barriers to getting services."

Despite the disparities, the authors say, having any form of dental insurance significantly increases the odds of seeing a dentist on a regular basis. The studied showed that 54 percent of privately insured children and 27 percent of publicly insured children had seen the dentist during the previous six months, compared with 12 percent of children without dental coverage.

"The data tell us that Medicaid and CHIP have improved children's ability to get dental care," Pourat said. "However, both programs need to do more to reduce disparities."

Rapily Assess Children's Tooth Decay Risk

Researchers at the Oregon Health & Science University School of Dentistry have determined that ATP-driven (adenosine triphosphate-driven) bioluminescence -- a way of measuring visible light generated from ATP contained in bacteria -- is an innovative tool for rapidly assessing in children at the chair-side the number of oral bacteria and amount of plaque that can ultimately lead to tooth decay.

The study is published online in the May-June 2010 issue of Pediatric Dentistry.

Caries (microbial disease) prevention is one of the most important aspects of modern dental practice. Untreated, large numbers of cariogenic bacteria adhere to teeth and break down the protective enamel covering, resulting in lesions and cavities. There is a critical need in dentistry to develop better quantitative assessment methods for oral hygiene and to determine patient risk for dental caries, because disease as well as restorative treatment results in the irreversible loss of tooth structure. Previous caries risk assessments have focused on social, behavioral, microbiologic, environmental and clinical variables.

The goal of the OHSU study was to examine the use of microbiological testing, specifically ATP-driven bioluminescence, for quantifying oral bacteria, including plaque streptococci, and assessment of oral hygiene and caries risk. Thirty-three randomly selected OHSU pediatric patients, ages 7 to 12, were examined, and plaque specimens, in addition to saliva, were collected from one tooth in each of the four quadrants of the mouth. The oral specimens were then assessed to count total bacteria and streptococci and subjected to ATP-driven bioluminescence.

The OHSU team found statistical correlations, linking ATP to the numbers of total bacteria and oral streptococci. Their data indicated that ATP measurements have a strong statistical association with bacterial numbers in plaque and saliva specimens, including numbers for oral streptococci, and may be used as a potential assessment tool for oral hygiene and caries risk in children.

"The use of ATP-driven bioluminescence has broad implications in dentistry and medicine and can be used translationally in the clinic to determine the efficacy of interventional therapies, including the use of mouth rinses and perhaps in the detection of bacterial infections in periodontal and other infectious diseases," noted Curt Machida, Ph.D., principal investigator and OHSU professor of integrative biosciences and pediatric dentistry.

The OHSU team included Machida; Shahram Fazilat, D.D.S., a 2008 pediatric dentistry graduate; Rebecca Sauerwein, research assistant in integrative biosciences; Jennifer McLeod, a fourth-year dental student who recently graduated; Tyler Finlayson, second-year dental student; Emilia Adam, D.D.S., M.P.H., a second-year pediatric dentistry resident who recently graduated; John Engle, D.D.S., interim chair of the Department of Pediatric Dentistry; Prashant Gagneja, D.D.S., associate professor of pediatric dentistry; Tom Maier, Ph.D., assistant professor of integrative biosciences and oral pathology and radiology.

The research was funded by Oral BioTech, the OHSU School of Dentistry, and the Oregon Clinical and Translational Research Institute, which is funded by a grant from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). Established in September 2006 through the NIH's Clinical and Translational Science Award (CTSA) program, OCTRI is a unique partnership between OHSU and Kaiser Permanente Center for Health Research -- bringing together an academic medical center and an innovative managed care organization. OCTRI's mission is to improve human health by enhancing clinical and translational research. OCTRI works with institutional partners, community organizations, and industry to engage communities in clinical research efforts and to reduce the time it takes for laboratory discoveries to become treatments for patients.