Brushing away oral health disparities in America’s rural children

Meaningful legislation addressing health care inequities in the U.S. will require studies examining potential health disparities due to geographic location or economic status.

An interdisciplinary team at the Medical University of South Carolina (MUSC) and the University of South Carolina (UofSC) report in the Journal of Public Health Dentistry that rural children are less likely to receive preventive dental care than urban children. Using samples from 20,842 respondents from a 2017 National Survey of Children’s Health, the team determined the existence of an urban-rural disparity in U.S. children’s oral health. This disparity can have serious consequences for children’s oral health.

 

 “When preventive care is delayed, the persistent exposure to things like refined sugars can promote bacterial growth,” said Amy Martin, DPH, a professor in the College of Dental Medicine at MUSC and senior author of the article. “When that bacteria grows, it can exacerbate the cycle of decay, which can only be disrupted by visiting the dentist for regular cleanings and parent education.”

The findings of this particular study are important to informing legislative change. Preparations for the 2020 Surgeon General’s report on oral health are currently underway. The original report, released in 2000, was a pivotal call to action to prioritize oral health in the U.S. As a result of this report, significant pieces of legislation were passed that addressed the nation’s inequities.

However, work still needs to be done to address inequities in oral health care for children. The National Advisory Committee on Rural Health and Human Services has also released oral health reports in response or as a prelude to the Surgeon General’s reports. In 2003, its report found that fewer rural children visited dentists annually than urban children. This statistic motivated the MUSC-UofSC team to investigate whether health disparities still existed between rural and urban children.

"It’s really important for researchers to examine access, utilization and outcomes among racial ethnic minorities and vulnerable populations living in rural areas. Unless we quantify these differences, there’s no way to know what kinds of policies that we need to be advocating for.” -- Dr. Elizabeth Crouch

“There has not really been a comprehensive study on what’s happening among rural children, compared to their urban counterparts, in the last five years,” commented lead author Elizabeth Crouch, MD., Ph.D. , assistant professor and deputy director of the Rural and Minority Health Research Center in the Arnold School of Public Health at UofSC. “This article may influence policy decisions in the near future.”

 

To understand oral health discrepancies between rural and urban children, the investigators used data from the 2017-2018 National Survey of Children’s Health, a nationally representative sample of children from the U.S. Along with collecting information about geographic location, family income, oral health condition, family structure and race, the survey asked about access to oral health care: Had a participant’s child received oral health care? Did the child regularly see a health care provider for preventive care such as checkups and dental cleanings?

The investigators found that rural children were less likely to have had a preventive dental visit than urban children. Furthermore, compared with urban kids, they were less likely to receive fluoride treatments or dental sealants, and their teeth were in poorer condition.

“It’s really important for researchers to examine access, utilization and outcomes among racial ethnic minorities and vulnerable populations living in rural areas,” said Crouch. “Unless we quantify these differences, there’s no way to know what kinds of policies that we need to be advocating for.”

Additionally, children who were uninsured or had caregivers with a high school education or less were less likely to have had preventive dental visits. These finding suggest that to improve preventive care in kids, policies should focus on increasing family income or dental insurance coverage.

Importantly, this study confirmed previous studies that found racial/ethnic minorities were less likely to receive preventive dental care than nonminorities.   

“Ultimately, illuminating these disparities, both quantitatively and qualitatively, will inform policy that can eliminate these disparities in oral health care in rural children,” said Crouch.