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