Written By Kevin Kerfoot / Reviewed By Ray Spotts
Children’s negative experiences at the dentist are linked to income, ethnicity and language, according to a study from the University of California, Irvine. The study - published in Academic Pediatrics - found that families with lower incomes or from ethnic or linguistic minority groups were more likely to report negative incidents, such as the child being physically restrained, separated from a caregiver or sedated without consent.
“The prevalence of developmentally inappropriate care significantly differed between lower-income, Latino or Asian families and higher-income or Caucasian families,” says Stephanie Reich, UCI associate professor of education and lead author of the study. “Although Medicaid expansion has greatly increased children’s oral healthcare coverage, utilization of services and health outcomes haven’t matched that growth.”
Research to date on oral healthcare use has focused primarily on structural issues, including insurance coverage, finding a Medicaid provider, transportation challenges and parental knowledge. Few studies consider the role that dentists and staff play in hindering or facilitating children’s oral healthcare utilization.
“We found that cost constraints, access to providers and lack of knowledge were not the primary barriers to initiating and continuing dental care,” Reich said. “The data suggest that negative experiences likely reduce the probability of returning or taking other children to the dentist.”
Focus groups with caregivers of young children were convened in four cities, followed by a survey - in English, Spanish and Vietnamese - of 1,184 caregivers of children under six between May 2016 and June 2018. Positive interactions at the dentist were reported most often by white caregivers, who were 2.26 times more likely to have had experiences that made them happy.
Upsetting incidents were much more common among low-income and minority families. “Our findings that nonwhite and low-income children were significantly more likely to experience developmentally inappropriate care demonstrate poor communication between providers and parents, and yet the role of dentists and their staff is not systematically studied. These data suggest it should be,” Reich said.
“They need to receive better training in how to work with young children and interact with diverse families, and the issue of identifying ways in which bias may alter the quality of care must be addressed too.”
How To Better Integrate Oral Health And Primary Care For Positive Dental Experiences
In practice, policy and education, oral health care and primary health care have traditionally been considered separate. In an effort to change that, a group of public health dentists has issued recommendations on improving the integration of the two with a goal to influence policymakers, clinicians, educators and health researchers.
In a paper, commissioned by the National Academies of Sciences, Engineering and Medicine’s Roundtable on Health Literacy, experts found that additional work is needed to integrate primary care and oral health to provide more comprehensive and improved access to care.
The authors, from the UCLA School of Dentistry and the University of North Carolina, also found that the amount of time devoted to oral health in health-professional training programs remains low and topics are limited.
“One of the biggest takeaways from our analysis was that the integration of primary care and oral health care is still in its early stages - with little guidance and support from professional associations, governing bodies and policymakers,” says lead co-author, Dr. Kathryn Atchison, professor of public health at the UCLA School of Dentistry and the Fielding School of Public Health.
“We see this report as a blueprint for policymakers to better understand what is needed to best serve the public in the rapidly changing health care delivery system.”
21 Recommendations For Better Dental Experiences
The report outlines 21 recommendations, including applying a comprehensive framework that includes integration theory, oral health and primary care - with attention to health literacy - into practice, education, research and policymaking; prioritizing oral health promotion and disease prevention in integration activities to reduce health disparities; exploring the best ways to establish formal collaboration and referral networks among health care systems, medical practices and dental practices in local regions; and developing and refining quality-of-care metrics that include the degree of integration between primary care and oral health
There are two examples of the experts’ recommendations already in practice - the UCLA–First 5 LA Children's Dental Care Program, established in 2012 by Dr. Jim Crall; and UCLA Dentistry’s Infant Oral Care Program, initiated in 2009 by Dr. Francisco Ramos-Gomez.
Both initiatives are designed to offer educational programs to care providers with a goal to provide preventative oral health services to children and improve oral health care. “Integration must be at the forefront of policymakers’ and educators’ minds in order to best prepare health care professionals to treat the general population,” added Dr. Paul Krebsbach, dean of the UCLA School of Dentistry.
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With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.
Founder Ray Spotts has a passion for all things natural and has made a life study of nature as it relates to health and well-being. Ray became a forerunner bringing products to market that are extraordinarily effective and free from potentially harmful chemicals and additives. For this reason Ray formed Trusted Health Products, a company you can trust for clean, effective, and healthy products. Ray is an organic gardener, likes fishing, hiking, and teaching and mentoring people to start new businesses. You can get his book for free, “How To Succeed In Business Based On God’s Word,” at www.rayspotts.com.