AMBULATORY PEDIATRICS Volume 2, Number 2 Supplement 141 Copyright  2002 by Ambulatory Pediatric Association March-April 2002 Disparities in Oral Health and Access to Care: Findings of National Surveys Burton L. Edelstein, DDS, MPH In this background paper, sociodemographic variables, including age, race, family income, sex, parental education, and geographic location, have been used to characterize the dental status of US children and their access to dental services. Because tooth decay, or dental caries, remains the preeminent oral disease of childhood and national data is available on dental office visits, tooth decay has been used as the primary marker for children’s oral health, and visits to the dentist is the marker for care. In general, children from low-income families experience the greatest amount of oral disease, the most extensive disease, and the most frequent use of dental services for pain relief. Yet these children have the fewest overall dental visits. Paradoxically, children in poverty—those living in households with annual gross incomes under $16 500 for a family of 4—or near poverty—those in family households with incomes between $16 500 and $33 000—also have the highest rates of dental insurance coverage, primarily through Medicaid and SCHIP. For those most affected, dental disease is consequential for their growth, function, behavior, and comfort. The twin disparities of poor oral health and lack of dental care are most evident among low-income preschool children, who are twice as likely to have cavities as are higher income children. Medicaid-eligible children who have cavities have twice the numbers of decayed teeth and twice the number of visits for pain relief but fewer total dental visits, compared to children coming from families with higher incomes. Fewer preventive visits for services such as sealants increase the burden of disease in low-income children. These disparities continue into adolescence and young adulthood, but to a lesser degree. Disparities in oral health status and access to dental care are also evident when comparing black, Hispanic, and Native American children to white children and when comparing children of parents with low educational attainment to children of parents with higher educational attainment. The fastest growing populations of children are those that currently have the highest disease rates and the lowest amount of dental care. If the strong correlation between these subpopulations and dental diseases continues, caries rates are likely to rebound after longstanding declines, and the stress on publicly financed dental care will likely increase. KEY WORDS: dental caries; dental pain; dental visits; Medicaid Ambulatory Pediatrics 2002;2suppl:141 147 T he Surgeon General’s Workshop on Children and Oral Health, convened in March 2000, addressed strategies to reduce oral health and dental care dis- parities among America’s children and youth. National de- scriptive data on children’s experience with dental caries and dental visits were reviewed in order to provide par- ticipants with an overview of these disparities. In this background paper, we used sociodemographic variables, including age, race, family income, sex, paren- tal education, and geographic location, to characterize the dental status of US children and their access to dental services. We have used tooth decay, or dental caries, as the primary marker for children’s oral health and visits to the dentist as the marker for care. We selected these 2 markers because tooth decay remains the preeminent oral disease of childhood and because we have reliable na- From the Children’s Dental Health Project, Washington, DC, and the National Oral Health Policy Center, Division of Community Health, School of Dental and Oral Surgery, Columbia University, New York, NY. Address correspondence to Burton L. Edelstein, Children’s Dental Health Project, 1625 Massachusetts Avenue NW, Suite 600, Wash- ington, DC 20036 (e-mail: bedelstein@cdhp.org). Received for publication March 23, 2001; accepted November 27, 2001. tional data for dental office visits. This contribution to the Workshop summarizes national data available through 1999. No secondary analyses or multivariate studies of interactions between sociodemographic factors were con- ducted. For this review, we selected data sources that represent the entire US population of children in the last decade. These sources include the 1986–94 Third National Health and Nutrition Examination Survey (NHANES), the 1993 National Health Interview Survey (NHIS), and the 1996 Medical Expenditure Panel Survey (MEPS). These are the same data sources used by the federal government to es- tablish health goals and to monitor progress toward achieving the goals outlined in Healthy People 2000 and Healthy People 2010. Little comparable information is available for the states, but when information is available, the state data tend to strongly reflect national findings. 1 DISPARITIES IN CARIES EXPERIENCE Caries Prevalence In a study of historical epidemiologic data, Brown 2 compared the oral health of children in the early 1970s with that of their counterparts in the late 1980s and early 1990s. He reported that, Although oral health differences based on poverty and