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Predictors of Unmet Dental Need in Children With Autism Spectrum Disorder: Results From a National Sample

      Abstract

      Objective

      Unmet dental need in children with autism spectrum disorder (ASD) is common. We tested hypotheses that lacking a medical home or having characteristics of more severe ASD is positively associated with having unmet dental need among children with ASD.

      Methods

      Using data from the 2009 to 2010 National Survey of Children with Special Health Care Needs, we analyzed 2772 children 5 to 17 years old with ASD. We theorized that unmet dental need would be positively associated with not having a medical home and having characteristics of more severe ASD (eg, parent reported severe ASD, an intellectual disability, communication, or behavior difficulties). Prevalence of unmet dental need was estimated, and unadjusted and adjusted odds ratios, 95% confidence intervals, and P values were computed using survey methods for logistic regression.

      Results

      Nationally, 15.1% of children with ASD had unmet dental need. Among children with ASD, those without a medical home were more apt to have unmet dental need than those with a medical home (adjusted odds ratio, 4.46; 95% confidence interval, 2.59–7.69). Children with ASD with intellectual disability or greater communication or behavioral difficulties had greater odds of unmet dental need than those with ASD without these characteristics. Parent-reported ASD severity was not associated with unmet dental need.

      Conclusions

      Children with ASD without a medical home and with characteristics suggestive of increased ASD-related difficulties were more apt to have unmet dental need. Pediatricians might use these findings to aid in identifying children with ASD who might not receive all needed dental care.

      Keywords

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      References

        • Yu S.M.
        • Bellamy H.A.
        • Kogan M.D.
        • et al.
        Factors that influence receipt of recommended preventive pediatric health and dental care.
        Pediatrics. 2002; 110: e73
        • Iida H.
        • Lewis C.W.
        Utility of a summative scale based on the Children with Special Health Care Needs (CSHCN) Screener to identify CSHCN with special dental care needs.
        Matern Child Health J. 2012; 16: 1164-1172
        • Lewis C.
        • Robertson A.S.
        • Phelps S.
        Unmet dental care needs among children with special health care needs: implications for the medical home.
        Pediatrics. 2005; 116: e426-e431
        • Bloom B.
        • Cohen R.A.
        • Freeman G.
        Summary health statistics for U.S. children: National Health Interview Survey, 2010.
        Vital Health Stat 10. 2011 Dec; : 1-80
      1. Surgeon General. Oral Health in America: A Report of the Surgeon General. United States Dept of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, Rockville, MD2000
        • Committee on Oral Health Access to Services
        • Institute of Medicine, National Research Council
        Improving Access to Oral Health Care for Vulnerable and Underserved Populations.
        National Academies Press, Washington, DC2011
      2. Centers for Disease Control and Prevention. Prevalence of the Autism Spectrum Disorders (ASDs) in Multiple Areas of the United States, 2004 and 2006: Community Report from the Autism and Developmental Disabilities Monitoring (ADDM) Network. 2006.

        • Centers for Disease Control and Prevention
        Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 1-19
        • Blumberg S.J.
        • Bramlett M.D.
        • Kogan M.D.
        • et al.
        Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012.
        Natl Health Stat Report. 2013; (1 p following 11): 1-11
        • Kopycka-Kedzierawski D.T.
        • Auinger P.
        Dental needs and status of autistic children: results from the National Survey of Children's Health.
        Pediatr Dent. Jan-Feb 2008; 30: 54-58
        • Lewis C.W.
        Dental care and children with special health care needs: a population-based perspective.
        Acad Pediatr. Nov-Dec 2009; 9: 420-426
        • Stein L.I.
        • Polido J.C.
        • Cermak S.A.
        Oral care and sensory over-responsivity in children with autism spectrum disorders.
        Pediatr Dent. 2013; 35: 230-235
        • Stein L.I.
        • Polido J.C.
        • Najera S.O.
        • Cermak S.A.
        Oral care experiences and challenges in children with autism spectrum disorders.
        Pediatr Dent. 2012; 34: 387-391
        • Stein L.I.
        • Polido J.C.
        • Mailloux Z.
        • et al.
        Oral care and sensory sensitivities in children with autism spectrum disorders.
        Spec Care Dentist. 2011; 31: 102-110
        • Lai B.
        • Milano M.
        • Roberts M.W.
        • Hooper S.R.
        Unmet dental needs and barriers to dental care among children with autism spectrum disorders.
        J Autism Dev Disord. 2012; 42: 1294-1303
        • Brickhouse T.H.
        • Farrington F.H.
        • Best A.M.
        • Ellsworth C.W.
        Barriers to dental care for children in Virginia with autism spectrum disorders.
        J Dent Child (Chic). 2009; 76: 188-193
        • Nelson L.P.
        • Getzin A.
        • Graham D.
        • et al.
        Unmet dental needs and barriers to care for children with significant special health care needs.
        Pediatr Dent. 2011; 33: 29-36
        • Strickland B.B.
        • Jones J.R.
        • Ghandour R.M.
        • et al.
        The medical home: health care access and impact for children and youth in the United States.
        Pediatrics. 2011; 127: 604-611
        • Martin A.B.
        • Crawford S.
        • Probst J.C.
        • et al.
        Medical homes for children with special health care needs: a program evaluation.
        J Health Care Poor Underserved. 2007; 18: 916-930
        • Homer C.J.
        • Klatka K.
        • Romm D.
        • et al.
        A review of the evidence for the medical home for children with special health care needs.
        Pediatrics. 2008; 122: e922-e937
      3. Data Resource Center for Child & Adolescent Health. Child and Adolescent Health Measurement Initiative (CAHMI). 2009-2010 NS-CSHCN: SAS Code for Data Users: Child Health Mesasures, Indicator and Subgroups, Version 1. May 2012. Available at: www.childhealthdata.org/learn/methods#Codebooks. Accessed July 27, 2014.

      4. Data Resource Center for Child & Adolescent Health. Child and Adolescent Health Measurement Initiative (CAHMI). National Survey of Children with Special Healthcare Needs (2009/10 NS-CSHCN): Fast Facts. Available at: http://www.childhealthdata.org/docs/default-document-library/ns-cshcn-fast-facts-2009.pdf. Accessed July 1, 2013.

      5. Data Resource Center for Child & Adolescent Health. 2009/10 National Survey of Children with Special Health Care Needs (2009/10 NS-CSHCN). Sampling and Survey Administration Process. Available at: http://childhealthdata.org/docs/default-document-library/2009-nscshcn-survey-sampling-administration.pdf. Accessed November 21, 2013.

        • Bethell C.D.
        • Read D.
        • Stein R.E.
        • et al.
        Identifying children with special health care needs: development and evaluation of a short screening instrument.
        Ambul Pediatr. 2002; 2: 38-48
        • McPherson M.
        • Arango P.
        • Fox H.
        • et al.
        A new definition of children with special health care needs.
        Pediatrics. 1998; 102: 137-140
      6. Data Resource Center for Child & Adolescent Health. Child and Adolescent Health Measurement Initiative (CAHMI). National Survey of Children with Special Health Care Needs (NS-CSHCN), 2009-2010: Guide to Topics & Questions Asked. Available at: www.childhealthdata.org/learn/topics_questions. Accessed July 27, 2014.

      7. Centers for Disease Control and Prevention. Autism Spectrum Disorder (ASD). Data & Statistics. Available at: http://www.cdc.gov/ncbddd/autism/data.html. Accessed May 22, 2014.

        • Savage M.F.
        • Lee J.Y.
        • Kotch J.B.
        • Vann Jr., W.F.
        Early preventive dental visits: effects on subsequent utilization and costs.
        Pediatrics. 2004; 114: e418-e423
      8. Health and Human Services. Visits to a dentist during the past year among those aged 2 years and older. Available at: http://drc.hhs.gov/report/dqs_tables/pdf/4.pdf. Accessed May 28, 2014.

      9. Data Resource Center for Child & Adolescent Health. 2009–2010 National Survey of Children with Special Health Care Needs. Available at: http://www.cdc.gov/nchs/data/slaits/NS_CSHCN_Questionnaire_09_10.pdf. Accessed May 21, 2014.

        • CAHMI - The Child and Adolescent Health Measurement Initiative
        Measuring Medical Home for Children and Youth: Methods and Findings from the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health.
        Oregon Health Sciences University, 2009
      10. Policy statement: organizational principles to guide and define the child health care system and/or improve the health of all children.
        Pediatrics. 2004; 113: 1545-1547
        • American Academy on Pediatric Dentistry Council on Clinical Affairs
        Policy on the dental home.
        Pediatr Dent. 2008; 30: 22-23
        • Hale K.J.
        Oral health risk assessment timing and establishment of the dental home.
        Pediatrics. 2003; 111: 1113-1116
        • dela Cruz G.G.
        • Rozier R.G.
        • Slade G.
        Dental screening and referral of young children by pediatric primary care providers.
        Pediatrics. 2004; 114: e642-e652
        • Rozier R.G.
        • Stearns S.C.
        • Pahel B.T.
        • et al.
        How a North Carolina program boosted preventive oral health services for low-income children.
        Health Aff (Millwood). 2010; 29: 2278-2285
      11. Pew Charitable Trusts. Reimbursing Physicians for Fluoride Varnish. Available at: http://www.pewstates.org/research/analysis/reimbursing-physicians-for-fluoride-varnish-85899377335. Accessed February 23, 2014.

        • Al Agili D.E.
        • Bronstein J.M.
        • Greene-McIntyre M.
        Access and utilization of dental services by Alabama Medicaid-enrolled children: a parent perspective.
        Pediatr Dent. 2005; 27: 414-421
        • Raposa K.A.
        Behavioral management for patients with intellectual and developmental disorders.
        Dent Clin North Am. 2009; 53: 359-373, xi
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Publishing, Arlington, Va2013