Oral health disparities in elementary school-aged children in the United States

Background: There are scant resources available to address oral health disparities among America's schoolchildren. To best target our efforts, it is imperative to understand clearly the unmet oral health needs and disparities in this group. Purpose: We examined the oral health needs, care access, and expenditures among schoolchildren ages 6-12 by race, sex, socioeconomic status (SES), dental insurance, and metropolitan residence. Methods: Data were retrieved from the Medical Expenditure Panel Survey (MEPS) Household, Medical Conditions, and Dental Visits Files for the years 2003-2007. The sample included 19,451 schoolchildren ages 6-12. We estimated logistic regression models to calculate oral health need and two-part models of dental expenditures to examine access and levels of expenditures. Estimates were adjusted for the complex survey design of the MEPS. Results: Low SES children had almost twice the odds of having dental problems (p < 0.001). Black children had almost 50% greater odds of oral health problems (p < 0.001). Girls and urban children also were at higher risk (p < 0.001). However, oral health service use and expenditures (both insurance and self-pay) were significantly lower amongst low SES and Black children (p < 0.001). Conclusions: There continues to be a significant disconnect in oral health, in that many of the children most in need of ongoing oral health care are the least likely to receive it. Poor and Black elementary schoolchildren are particularly vulnerable to poor oral health, and should be the focus of school and community based efforts to reduce oral health disparities.