Flickr photo by National Institute for Occupational Safety and Health
Latino and African-American children in California, whether covered by private insurance or Medicaid, visit dentists less frequently than their white counterparts. Overall, 24 percent of kids in the state have never been to the dentist.
The findings are part of a study on racial and ethnic disparities in dental care for children, published this month in the journal Health Affairs. The study analyzed data for nearly 11,000 children ages 11 and under in the 2005 California Health Interview Survey.
"We know that racial, ethnic disparities do exist" in dental care, said Nadereh Pourat, lead author of the study and director of research planning at the UCLA Center for Health Policy Research. Public insurance programs improve access to care for low-income populations, which often include ethnic minorities, but they do not overcome all barriers to care, Pourat said.
For example, even when controlling for type of dental insurance, data showed that African-American and Latino kids were 39 and 36 percent, respectively, more likely to have longer intervals between dental visits compared to white children.
Among the study's findings:
- Forty percent of uninsured children have never seen a dentist. Among children covered by public insurance, 27 percent in Medicaid, 16 percent in the Children's Health Insurance Program and 15 percent in other public programs have never seen a dentist. Seventeen percent of privately insured children have not seen a dentist.
- Residents of four California regions – the Sacramento area, the San Joaquin Valley, Los Angeles County and other southern counties – were more likely than San Francisco Bay Area residents to have had longer times since their last visit. This could reflect the uneven distribution of dentists in the state.
- Nearly 40 percent of children under age 3 have few or no dental visits. Most dental and public health organizations recommend that children see a dentist by age 1 or by the time they have their first tooth, and that they do so regularly.
Pourat and co-author Len Finocchio, a senior program officer at the California HealthCare Foundation, explore a few barriers to care, including the number of dentists participating in Medicaid. About 42 percent of California dentists participate in Medicaid, compared to about 50 percent or lower nationally. Many rarely or never treat children in the program, they said.
"One of the issues dentists continually argue for is better payment. They say the payments are not sufficient to take care of these children and do all the paperwork and authorizations and administrative work that's necessary," Pourat said.
Reimbursement rates for Medicaid are one-half to one-third of typical fees in California. "Maybe we need to think about those payments for children particularly," she said. "Most children need really basic cleaning and preventative care. It's less expensive to take care of children than adults."
About 6.3 million children – two-thirds of all children in the state – suffer from poor oral health by the time they reach third grade, according to the California HealthCare Foundation. In 2007, about 7 percent of kids in the state missed school because of a dental problem, excluding time for cleaning or routine check-ups.