Tooth Decay among Economically Disadvantaged Children in Texas--the Effect of Living on the U.S.-Mexico Border

Background: Although tooth decay is largely preventable, it remains the most common chronic disease among children, especially those from low income families. Healthy People 2010 objectives include reduction of untreated dental decay in 6-8 year old children. This study examined the association between place of residence and tooth decay among economically disadvantaged children.

Methods: Oral health surveillance data collected from August 2004-May 2006 via a school-based survey of 9,530 children aged 6-8 comprised the dataset for analysis. The survey sample represented the population of economically disadvantaged children in Texas schools. Schools with at least 50% of students on the federal free/reduced lunch program were selected for participation. Multivariate logistic regression was used to examine predictors of untreated dental caries. Standard errors were adjusted for clustering at the school level.

Results: Adjusting for age, sex, and race/ethnicity, 6-8 year old children living on the border had lower odds of untreated dental caries (AOR: 0.79, 95% CI: 0.68-0.93). However, adjusting for Medicaid status attenuated this association (AOR: 0.84, 95% CI: 0.72-0.99). Being insured by Medicaid showed a significant protective effect against prevalence of untreated dental decay, adjusting for demographic variables and place of residence (AOR: 0.65, 95% CI: 0.60-0.71).

Conclusion: The high Medicaid participation rate among dentists in border areas of Texas may partly explain the lower odds of untreated dental caries among among children on the Texas-Mexico border. In addition, the preventive dental care provided for children by the Medicaid program explains the independent protective effect of being insured by Medicaid.