272 - Disparities in the Oral Health of Children with Medical Complexity

Poster Number: 272
Publication Number: 272.160

Background: Children with special health care needs (CSHCN) have worse oral health outcomes than children without special healthcare needs, despite increased preventive oral health service use. Children with medical complexity (CMC), a subgroup of CSHCN with the most serious medical conditions resulting in functional limitations, may be at even higher risk for oral health diseases, but their oral health status is not well characterized.

Objective: To compare oral health status between CMC and CSHCN using a nationally representative sample.

Design/Methods: Cross-sectional analysis of annual data from the 2016-17 National Survey of Child Health. CMC and CSHCN were identified using validated algorithms. The primary outcome was oral health status, as measured by a child’s caregiver-reported current condition of teeth and cavities and toothaches in the past year; secondary outcomes included oral health service use. Bivariate analyses compared the prevalence of the oral health status and service use by medical complexity status. Multivariable logistic regression was used to assess the relationship between oral health outcomes and complexity, adjusting for variables known to affect oral health outcomes of CSHCN. All statistics accounted for the complex survey design.

Results: Of 16,178 CSHCN ages 1–17 years, 6% were CMC and 94% were “non-CMC” CSHCN. CMC were 2 times more likely than CSHCN to have fair or poor teeth condition (19% vs 9%; p< 0.001) and a slightly higher but non-significant rates of cavities and toothaches (Table 1). After adjusting for independent variables, the odds of fair or poor teeth condition remained higher for CMC (odds ratio: 1.54; 95% confidence interval: 1.01-2.34). CMC and CSHCN had no difference in rates of seeing a dental provider for a preventive visit in the past year (87 vs 84%, p=0.12) or receiving other preventive dental services (dental cleanings, x-rays, sealants) except that CMC were more likely to have fluoride varnish applied (61 vs 54%, p=0.042). Six percent of CMC and 4% CSHCN reported not getting dental care when needed (p=0.081).

Conclusion(s): In this study, 1 in 5 CMC had poor oral health status. CMC have poorer reported oral health than non-CMC CSHCN, despite similar access to preventative dental services. This disparity could reflect factors unique to CMC that impact oral health such as behavioral and physical limitations to oral care, exposure to polypharmacy, or prioritization of multiple care needs. Further study of such factors could identify modifiable targets to improve oral health and potentially reduce negative effects on overall health of CMC.