Running head: IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

Improving Access to Oral Healthcare for Children

Whitney A. Gau and Emily A. Hunt
LIT Dental Hygiene Program

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

Abstract
Improving access to childrens oral healthcare involves many different factors. Dental visits are a
vital aspect of childrens oral healthcare. These visits involve teeth cleaning, preventive measures
such as fluoride, patient education, identifying and restoring carious lesions, and the ability to
detect other harmful oral lesions. Access to these amenities is crucial in forming a positive future
for a childs oral health. Medicaid is another important aspect of access to dental care for a child.
Research has shown that children covered by Medicaid or Childrens Health Insurance Program
(CHIP) have almost the same access to dental care as privately-insured children, and better
access than children without insurance. Therefore, children covered by Medicaid still encounter
barriers to accessing dental care. There are several different organizations that strive to better the
oral health of children, and ultimately contribute to improved access to oral healthcare for the
children that they reach. These organizations include the School-Based Dental Sealant Program,
Fluoride Fest, and Texas Mission of Mercy. There is a dire need in our country for improved
access to care for children. This is more than likely due to parents lack of knowledge, difficulty
of finding transportation to dental visits, neglect, finances, or lack of dental insurance. Dental
healthcare providers should do everything possible to impact childrens health and life by
improving access to oral healthcare.

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

Dental caries remains at the top of the list as the most infectious disease found in
children. (olak, Dlgergil, Dalli, Hamidi, 2013). This is one example as to why it is so
important for children to have adequate access to oral healthcare. First of all, a child who is
brought up going to the dentist office regularly will be accustomed to the oral examinations,
preventive measures, and oral instructions given by the dentists and dental hygienists, and are
therefore more likely to continue this pattern of regular dental visits throughout their lifetime.
Even more than that, this early exposure to dental visits could possibly affect whether they bring
their own children to regular dental visits someday, and as a result, positively affect the oral
healthcare of the next generation. Secondly, children who have access to oral healthcare from an
early age will learn how to properly care for their oral cavity; for instance, how to brush and
floss their teeth, which foods and drinks are cariogenic, the effects of tobacco on the oral cavity,
etc. These techniques and facts will be taught to the children by dental hygienists if they attend
regular cleaning appointments. This knowledge gives children an opportunity to develop healthy
habits early in life in order to prevent disease. Lastly, childrens access to oral healthcare will
allow dental providers to detect childhood caries, gingivitis, malpositioned teeth, candidiasis, and
any other oral lesions that need to be treated. These findings may make evident a childs need of
fluoride supplementation, orthodontic treatment, or a prescription medication. With this said,
many people in this country are suffering from a lack of access to oral healthcare. Whether due
to disability, advanced age, or low-income in our nation, these people are all of importance. This
paper, however, will be concentrating on ways to improve access to oral healthcare for children.
According to Gurenlian (2011), we must prioritize disease prevention and health promotion,
provide oral health services in a variety of settings, rely on a diverse and expanded array of
providers who are competent, compensated, and authorized to provide evidence-based care,

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

foster continuous improvement and innovation (p. 8). It is very important for dental health
professionals to be concerned with the oral healthcare of children, and to focus on what can be
done to improve it. Two topics will be addressed in this paper: 1) How Medicaid is related to
access to oral healthcare for children; and 2) organizations involved in improving access to oral
healthcare for children.
Medicaid has already played a significant role in breaking down barriers to oral
healthcare for children. Studies show that the number of children receiving dental care doubled
between the years 2000 and 2010. This increase of oral healthcare made accessible to children is
in part due to the rise in the amount of children covered by Medicaid between the years 2000 and
2010. Ku, Sharac, Bruen, Thomas, and Norriss study (2013) states, Part of the increase was
because the overall number of children covered by Medicaid rose by 12 million (50%), but the
percentage of children who received dental care climbed appreciably from 29.3% in FFY 2000 to
46.4% in FFY 2010 (p. E1). However, there are many children in the United States that remain
to be in dire need of access to oral healthcare. Children who are not covered by Medicaid, CHIP,
or private insurances have the most difficulty in accessing dental care. Yet, it has been made
evident that children who are covered by Medicaid also face opposition to accessing oral
healthcare. In 2007, the tragic death of a 12-year-old Maryland boy, Deamonte Driver, who died
from a brain infection caused by an untreated tooth infection, brought attention to the difficulties
Medicaid-enrolled children could face in accessing dental care (Otto, 2007) (Ku et al., 2013, p.
E2). This incident prompted lawmakers to take action. A requirement for CHIP programs to
cover dental services was included in the Childrens Health Insurance Program Reauthorization
Act of 2009 (CHIPRA). Also, a requirement was made for the Department of Health and Human
Services to tell clients about a website listing dentists who serve patients covered by Medicaid or

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

CHIP. According to Ku et al., Dental care is a key component of Medicaids Early and Periodic
Screening, Diagnostic, and Treatment (EPSDT) benefit (p. E2). In other words, Medicaid has
made dental care a priority, specifically for children, given that EPSDT is not a part of adult
Medicaid benefits.
Ku et al.s study (2013) uncovered the following:
Prior research has found that low-income children have poorer access to dental care and a
higher prevalence of dental caries than higher-income children (Shi & Stevens, 2005;
Dye, Li, & Beltran-Aguilar, 2012). However, research has also shown that, when holding
constant socioeconomic factors, children covered by Medicaid or CHIP tend to have
similar access to dental care as privately-insured children, and better access than
uninsured children (Dubay & Kenney, 2001; Duderstadt, Hughes, Soobader, &
Newacheck, 2006; Perry & Kenney, 2007). (p. E2)
It is inevitable that the fate of childrens oral healthcare remains in the hands of their parents or
guardians and their willingness to make it possible for their children to see a dental provider for
their oral healthcare needs. The cause of most parents neglect of their childrens oral healthcare
is widely due to a lack of knowledge about the importance of dental care and how it relates to
overall health. It is also due to a lack of knowledge about the benefits available to them under
Medicaid and difficulty with transportation to dental appointments. In 2011, the Centers for
Medicare and Medicaid Services (CMS) introduced an Oral Health Strategy. More barriers to
childrens oral healthcare have been recognized, such as low reimbursement rates for dental
providers, which, as a result causes fewer dentists to be willing to accept Medicaid coverage in
their office.
Ku et al.s study (2013) found the following:

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

The Oral Health Strategy consists of five components: 1) working with states to develop
pediatric oral health action plans; 2) strengthening technical assistance to states and
facilitating state/tribal peer-to-peer learning; 3) bringing outreach to providers; 4)
providing outreach to beneficiaries; and 5) partnering with other HHS agencies. (p. E2)
If oral healthcare providers will apply these guidelines to improve access to oral healthcare for
children, they have the opportunity to make this decade even more successful in breaking down
barriers to oral healthcare. The remainder of this paper will address one of the five components
of the Oral Healthcare Strategy of 2011; that is, organizations involved in improving access to
oral healthcare for children.
Implementation of different programs is important and necessary to increase dental health
knowledge and provide preventive dental services to underprivileged children. According to
Austin (2011), Perhaps underscoring access to care as a major concern, the incidence of dental
caries is greater in rural communities (p. 18). It is necessary to take action and reach out to
communities in order to decrease the incidence of caries in children and provide oral health
education to children and parents in hopes of increasing their awareness concerning the
importance of oral health. These programs range from the School-Based Dental Sealant Program
and Fluoride Fest to Texas Mission of Mercy. There are many such organizations but our focus
will remain on these three.
The School-Based Dental Sealant Program is used to treat children of low socioeconomic status while at school. This helps to eliminate certain barriers that may have prevented
the child from receiving dental treatment such as transportation, time, and money.
According to Devlin and Nguyens study (2011):

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

Study findings indicate that school-based dental sealant programs can increase the
prevalence of dental sealants and can help to reduce or eliminate the racial and economic
disparities in the prevalence of sealants. By removing certain barriers, such as cost, time
and transportation, school-based dental sealant programs can successfully provide
preventive dental services to schoolchildren. (p. 212)
Through this program, dental professionals are able to provide dental screenings including,
number of teeth filled, number of teeth with untreated decay, number of teeth extracted,
identification of first permanent molars with existing sealants and identification of first
permanent molars in need of sealants (Devlin & Henshaw, 2011, p. 213) and dental health
education. By implementing the dental sealant program, they hope to promote both the
importance of oral health and the importance of receiving necessary dental services (Devlin &
Henshaw, 2011, p. 216). The goal of the program is to locate and help children that may need
further restorative treatment. (Devlin & Henshaw, 2011).
The second program, Fluoride Fest, was created by the Smiles Foundation and provides
three different protective services: an oral evaluation, fluoride varnish application and dental
sealant placement. (Banton & Nguyen, 213, p. 22). While this program is similar to the last, it
provides the extra addition of fluoride varnish as a preventive measure for caries. This program
is also held at school and has four to five stations including oral hygiene instruction, nutrition
education, physical fitness, and dental sealants/fluoride varnish application with portable
equipment (Banton & Nguyen, 2013, p. 22). This program also helps to eliminate barriers such
as transportation and cost that would keep the children from receiving dental care.

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

The third public health program available is the Texas Mission of Mercy (TMOM). This
organization provides extended care that includes almost all services provided at a general
practice.
According the Banton and Nguyen (2013) findings from the Texas Dental Association
Smiles Foundation (TDASF):
TMOM is a mobile dental clinic that travels around the state providing free dental care to
uninsured Texans. These events provide cleanings, fillings, extractions, limited number of
partials and in most cases relief from pain. All services rendered at TMOMs are free of
charge to patients. (p. 22)
It takes collaboration with dental hygiene schools, local dental hygiene components and high
schools (Banton & Nguyen, 2013, p. 22) to keep a program such as this one running. While this
program is geared towards the general public and not just children; as such, it plays an important
role in increasing awareness and providing necessary dental care to all age groups.
Due to the lack of knowledge and resources available, many children are suffering from a
lack of dental care. Whether it is from Medicaid issues, transportation, or finances there seems to
be a need for improved access to dental care and education for children. Providing care for
underprivileged communities is vital in raising awareness of the importance of oral health. There
may be extra work, time, and effort involved in organizing these programs locally but somebody
has to do it. Will you be the one to take the first step?

IMPROVING ACCESS TO ORAL HEALTHCARE FOR CHILDREN

References
Austin, L. D. (2011). Mobile Dental Health Units: A Model for Improving Access to Care.
Access, 25(4), 18-19.

Banton, J., & Nguyen, C. (2013). Public Health Programs: Improving Access to Care through
Collaboration. Access, 27(8), 22-24.

olak, H., Dlgergil, . T., Dalli, M., & Hamidi, M. M. (2013). Early childhood caries update: A
review of causes, diagnoses, and treatments. Journal of Natural Science, Biology, and
Medicine, (4)1, 29-38. doi: 10.4103/0976-9668. 107257

Devlin, D., & Henshaw, M. (2011). Improving Access to Preventive Dental Services through a
School-Based Dental Sealant Program. Journal of Dental Hygiene: JDH / American
Dental Hygienists' Association, 85(3), 211-219.

Gurenlian, J. R. (2011). Looking Ahead. Improving access to care. RDH, 31(9), 8-16.

Ku, L., Sharac, J., Bruen, B., Thomas, M., & Norris, L. (2013). Increased Use of Dental Services
by Children Covered by Medicaid: 2000-2010. Medicare & Medicaid Research Review,
3(3), E1. doi:10.5600/mmrr.003.03.b01