title: The effect of rural residence on dental unmet need for children with special health care needs.
abstract: BACKGROUND
  Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs.
  
  
  OBJECTIVE
  To examine the effects of rural residence on unmet dental need for CSHCN.
  
  
  METHODS
  We use the nationally representative National Survey of CSHCN Needs. We performed logistic regression to estimate the independent effects of rural residence on the likelihood of having an unmet dental need, using a measure of unmet need based on professional society recommendations and a measure based on parental report.
  
  
  RESULTS
  Using either of the measures, a substantial percentage of CSHCN do not receive all needed dental care. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Our results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need.
  
  
  CONCLUSIONS
  Traditional access barriers for rural children, such as inadequate provider supply and lack of insurance, may increase unmet needs both directly and indirectly, through their effects on parents' perceptions of need. Reducing unmet needs for dental care in rural children with special needs will require addressing both access issues and parents' understanding of dental care need.
authors.affiliation: Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. asheley_skinner@unc.edu
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Slifkin
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Mayer
mesh_terms: D002648:Child; D002675:Child, Preschool; D019140:Dental Care for Children; D019988:Children with Disabilities; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D010290:Parents; D012423:Rural Health; D019035:Rural Health Services; D014481:United States