Oral Health Disparities in Children with Special Needs

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DESCRIPTION (provided by applicant): Children with special health care needs (CSHCN) comprise about 12.5 million or 18% of US children under age 18, though prevalence estimates range from 4%-32% depending on the definition used. Based on data from the 1994-95 National Health Interview Survey on Disability, dental care is the most prevalent unmet health care need of CSHCN. Most of the information about the oral health status of this underserved group comes from small, unrepresentative samples, local or regional reports, or studies of adults. Available information indicates that this group surfers from severe oral health disparities including poor oral health and untreated dental disease. This project will analyze publicly available data from the third National Health and Nutrition Examination Survey, 1988-94 (NHANES III) to describe the oral health status of this group, and to compare the national prevalence and severity of dental caries, periodontal conditions, tooth loss and incisor trauma in CSHCN ages 2-17 years to similarly aged children without special needs. We will also compare unmet dental needs and access to care in CSHCN to that of their peers without special needs. Because this is a diverse group, analytical strategies are designed to compare children hypothesized a priori to be at high risk for caries because of chronic illness that negatively impacts their oral health, medication use with adverse effects on the ora cavity, or functional limitations (physical and cognitive) that affect self-care practices. The federal Maternal and Child Health Bureau definition of CSHCN will be used as well as others. Data from nearly 10,300 children ages 2-17 years participating in NHANES III will be analyzed using SAS arid SUDAAN to account for the complex survey design in this nationally representative sample, and account for potential confounders and effect modifiers. The result of these analyses will direct our formulation of research hypotheses and appropriate interventions for testing in future studies of CSHCN.