Access to and utilization of dental care services among children with special health care needs in the United States

OBJECTIVE: To evaluate access and utilization of both preventive and other dental care services among Children with Special Health Care Needs (CSHCN) in the US in 2005 and 2009. METHODS: We analyzed data for 81,082 CSHCN from the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005 and 2009. The three main dependent variables were: access to and utilization of dental care, and health insurance status. The independent variables were: gender, age, race/ethnicity, type of insurance, number of criteria met on the screener tool, federal poverty level (FPL), family structure, language, family work life, financial burden and out-of-pocket expenses. Bivariate and multivariate weighted analyses were conducted to evaluate the study outcomes. RESULTS: We found that CSHCN had a high degree of access and utilization of the dental care system in the US. In 2005, 98.2% and 99.03% of CSHCN had “very good to good” access to preventive dental care and other dental care, respectively, and in 2009, the access was 98.1% and 98.7% for both services, respectively. Further, in 2005, 92.9% and 90.4% “fully utilized” preventive dental care services and other dental care, respectively, while 91.9% and 84.7% of CSHCN “fully utilized” both services respectively in 2009. Barriers to access dental care were commonly seen among CSHCN of an older age (5-17 years old), other Non-Hispanics, those from low-income families, with complicated health conditions, living with single mothers, who were uninsured or publically insured, and having family out-of-pocket expenses of more than $250 for their health services. Low levels of utilization were found among non-Hispanic Blacks, Hispanics and other Non-Hispanics CSHCN, from low-income families, with complicated health conditions, who were uninsured or publically insured, having family out-of-pocket expenses of more than$250 for their health services and had other unmet specialist care needs. Hispanic CSHCN from low-income families were more likely to be uninsured. Family work life and family financial status were both significantly associated with access and utilization of dental care services in 2005 and 2009. CONCLUSION: Although the results of this study show that, in 2005 and 2009, CSHCN accessed and utilized both preventive and other dental care services at a high level, disparities still exist among some CSHCN

Dental care beyond BC Children’s Hospital : perspectives on the transition experience for young adults with special health care needs

Objectives: To determine the extent to which young adults with special health care needs (YASHCN) who transitioned from care at BC Children’s Hospital Department of Dentistry (BCCH-DD) with/without the help of their caregivers were successful and satisfied in establishing a dental home and, to understand this transition process from the perspective of the dentists who care for them. Methods: This cross-sectional study sampled two populations: YASHCN or their caregiver and dental providers known to care for persons with disabilities (PWD). YASHCN: Eligible subjects (n=80) born 1996 or earlier and discharged from care at BCCH-DD were identified. Demographic variables and medical diagnosis were collected from dental records. Subjects were surveyed by telephone to determine the accessibility, satisfaction, and barriers to dental care services. Dentists: Dentists identified as providers (n=11) for PWD were surveyed to collect practice demographics, education, and knowledge related to treatment of PWD. Univariate and bivariate analysis, and thematic description interpreted the data. Results: YASHCN: forty subjects (50%) consented to participate in the telephone survey. The majority of YASHCN reported good/excellent oral health (57%), had seen a dentist in the last 12 months (70%), felt they had received what was needed (68%), and were satisfied/somewhat satisfied with the care they received (75%). Medical complexity, lack of awareness about dental needs and issues related to the transition process (poor communication, extended wait time for adult facility uptake) were reported as barriers. Dentists: Eight dentists (72%) participated in the survey. Patient cooperation, age, and severity of medical condition influenced the dentists’ decision to treat PWDs. Dentists confirmed YASHCN’s reported access difficulties and made recommendations to address personal (behavior, age), family (caregiver involvement) and system level (insurance, hospital/anesthesia access) issues. Conclusions: The majority of YASHCN/caregivers expressed satisfaction with their present dental status and dental care access. Their concerns, along with the recommendations of dental providers, should be considered in the refinement of the transition experience from BCCH-DD to adult care settings and also used to further advocate for dental care access for PWD of all ages.Dentistry, Faculty ofGraduat

Effect of a Vibration System on Pain Reduction during Injection of Dental Anesthesia in Children: A Randomized Clinical Trial

Background. The ‘‘gate control’’ theory suggests pain can be reduced by simultaneous activation of larger diameter nerve fibers using appropriate coldness, warmth, rubbing, pressure, or vibration. This study investigated the efficacy of a device combining cold and vibration, for needle-related procedural pain in children. Methodology. A total of 51 children aged 5–12 years participated in this randomized controlled clinical trial. Half of the children were in the control group and received maxillary buccal infiltration, by injecting 1.8 ml of 2% lidocaine with 1 : 100,000 adrenaline using topical anesthesia 20% benzocaine gel for 15 seconds, while the other half were in the test group and received the same anesthesia using a commercially available external cold and a vibrating device. A face version of Visual Analogue Scale (VAS) was used as a subjective measure to assess the child’s pain experience. The parents were requested to evaluate the child’s ability to tolerate pain using a behavioral/observational pain scale. Sound, Eyes, and Motor (SEM) scale and Faces, Legs, Activity, Cry, and Consolability (FLACC) scale were used to record the child’s pain as perceived by the external evaluator. T-test or Mann–Whitney U-test was used for scale variables, paired sample T-test or Wilcoxon rank t-test was used for before and after data, and chi-square was used for categorical variable, based on the results of normality test. Results. The results showed a statistically significant reduction in pain after the injection for the test group compared with control using VAS scale (mean = 6.68 (1.09) and 8.42 (0.50); p=0.001) and FLACC scale (mean = 5.92 (1.05) and 8.16 (0.54); p=0.002), but not when using SEM scale (mean 3.22 (0.42) and 4.24 (2.74);p=0.08). Conclusions. Combined external cold and vibrating devices can be an effective alternative in reducing experienced pain and fear in children undergoing infiltration dental anesthesia. This study was registered with clinical trial registry of the United States National Institutes of Health (NIH) at ClinicalTrials.gov (NCT03953001)