This paper grew out of an American Academy of Pediatrics project reviewing progress in the area of children's oral health since the Surgeon General's Report on Oral Health. It includes a summary of key advances in national dental care and oral health surveillance of children with special health care needs (CSHCN), and presents more recent national data on dental care need among CSHCN. Prior to the year 2000, there existed no population-based study describing the dental care utilization or needs among children with special health care needs (CSHCN) residing in the United States. When Oral Health in America: a Report of the Surgeon General was published that year,1
it addressed oral health of disabled populations only briefly, in large part, according to the authors, because there were such limited data available. In April, 2000, Newacheck and colleagues published a sentinel paper entitled, Access to Health Care for Children with Special Health Care Needs.2
This paper relied on data from the 1994-5 National Health Interview Survey (NHIS) on Disability and represents the first time, to our knowledge, that dental care was described as the leading unmet health care need among US CSHCN.
Since Newacheck's article, other population-based studies have been published, furthering our understanding of dental care needs and access of CSHCN. Key to expansion of research on this topic was the formal definition of CSHCN by the Maternal and Child Health Bureau (MCHB) (textbox)3
as well as the development of a screening instrument that operationalized this definition. This validated tool, called The Children with Special Health Care Needs Screener,3
is intended to be broadly inclusive and non-condition specific and dichotomously classifies children as having a special health care need (SHCN) or not. The CSHCN screener is now a component of several national surveys including the Medical Expenditure Panel Survey (MEPS) administered by the US Agency for Health Care Quality and Research (AHRQ),4
the National Survey of Children with Special Health Care Needs (NS-CSHCN),5
and the National Survey of Children's Health (NSCH).6
The latter 2 are MCHB-funded surveys conducted by the National Center for Health Statistics (NCHS) of the CDC (Centers for Disease Control). The capability to uniformly define CSHCN and relate this to the dental care and oral health variables within these 3 nationally-representative surveys has produced a respectable expansion in oral health research focused on US CSHCN in the last decade. We summarized published dental -related findings from these surveys in .
Summary of published studies from nationally representative survey including CSHCN with dental-related findings
The second iteration of the NS-CSHCN (“2006 NS-CSHCN”)5
is the focus of this research. Some revisions since the 2001 NS-CSHCN were relevant to better understanding dental care needs of CSHCN. Specifically, in the 2006 version, we are now better able to identify specific subgroups with more unmet dental care need, to separate out preventive vs. “other dental care” (e.g. fillings and other restorative dental care) and to make comparisons between children with and without SHCN. Without a non-special needs comparator group, it had previously been difficult to know whether disparities in dental care access were associated with a child's special need or with other factors that may disproportionately affect CSHCN.
We had the following objectives: 1) to determine, from a population perspective, a more current prevalence of unmet dental care needs, including preventive and other dental care, among CSHCN and compare this to children without SHCN, 2) within the constraints of cross-sectional data, to compare 2001 CSHCN findings to those of 5 years later, and 3) to identify factors associated with a greater odds of unmet dental care needs in CSHCN. We were particularly interested in the impact of condition severity as well as whether poverty, which we knew from our previous work to be an independent risk factor for unmet dental care, mediated the effect of condition severity on unmet dental care need.