Caregivers’ Characteristics Affect their Children’s Dental Care-Seeking Pattern

Objectives: Early establishment of a dental home is fundamental in improving children’s oral health but there is little information about how young high-risk children enter the dental care delivery system. Our objectives were to 1) describe how a population-based cohort of young Medicaid-enrolled children entered the dental care system and 2) determine whether caregiver factors influenced their children’s dental care-seeking patterns. Methods: We used child Medicaid claims and caregiver interview data for 1269 caregiver/child dyads enrolled during 2007-08 in the Carolina Oral Health Literacy Project. For a subset of 1000 children who had no prior dental visit, we examined prospectively the incidence of entry into the dental care system and the type of first visit. Outcomes were “entry into the dental care system” (yes versus no) and “first dental contact” (comprehensive oral evaluation versus a problem-focused visit)”. We measured Oral Health Status (OHS) using the NHANES-item, literacy with REALD-30, and dental neglect (DN) with the Dental Neglect Scale. Analyses relied on descriptive, bivariate and multivariate methods. Results: Children’s mean age at baseline was 16 months. Over a median follow-up of 25 months, 45% had a first dental visit. Children of caregivers with worse OHS and higher DN were less likely to enter the system. Conversely, children with fair/poor OHS were more likely to enter, but this visit was 3 times more likely to be an emergency visit as compared to visits of children with better OHS. Literacy was consistently associated with favorable dental care-seeking patterns but its effect was weak. Conclusions: Caregivers’ attitudes play a pivotal role in children’s oral health and dental care and are important determinants of their dental care-seeking behavior. Interventions aimed at improving pediatric oral health should rely on community outreach to engage caregivers in a culturally appropriate manner when their children are infants or toddlers.