title: Unmet dental needs and barriers to care for children with significant special health care needs.
abstract: OBJECTIVE
  The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis.
  
  
  METHODS
  A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts.
  
  
  RESULTS
  The study yielded 1,128 completed surveys. More than 90% of the children had seen a dentist within the past year; 66% saw a pediatric dentist, and 21% needed intense behavioral interventions. Although most families had high education levels, private dental insurance, and above average incomes, 20% of CSHCN had an unmet dental need. Children with craniofacial anomalies had twice as many unmet needs and children with cystic fibrosis had fewer unmet needs. Children with cerebral palsy, autism, developmental delay, and Down syndrome had more aversions to dental treatment, more treatment complications posed by their medical conditions, and more difficulty finding a dentist willing to provide care. Children with cystic fibrosis, metabolic disorders, or hemophilia encountered fewer barriers to care.
  
  
  CONCLUSIONS
  The data paint a picture of high unmet dental needs with subpopulations of children with special health care needs who are more at risk for system barriers and internal family barriers to care based on their medical diagnoses.
authors.affiliation: Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA. Linda.Nelson@childrens.harvard.edu
authors.forename: Linda P
authors.initials: LP
authors.lastname: Nelson
authors.forename: Anne
authors.initials: A
authors.lastname: Getzin
authors.forename: Dionne
authors.initials: D
authors.lastname: Graham
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.forename: Elke M
authors.initials: EM
authors.lastname: Wagle
authors.forename: Jessie
authors.initials: J
authors.lastname: McQuiston
authors.forename: Suzanne
authors.initials: S
authors.lastname: McLaughlin
authors.forename: Akshay
authors.initials: A
authors.lastname: Govind
authors.forename: Matthew
authors.initials: M
authors.lastname: Sadof
authors.forename: Noelle L
authors.initials: NL
authors.lastname: Huntington
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D003730:Dental Care for Persons with Disabilities / Q000706:statistics & numerical data*; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008404:Massachusetts; D009909:Oral Health; D010290:Parents; D019989:Persons with Intellectual Disabilities / Q000706:statistics & numerical data; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires