title: The impact of the Great Recession on untreated dental caries among kindergarten students in North Carolina.
abstract: BACKGROUND
  The authors conducted a study to determine the impact of the Great Recession on untreated dental caries in kindergarten-aged children in North Carolina (NC).
  
  
  METHODS
  During the seven school years from 2003-2004 through 2009-2010, the state dental public health program assessed 608,339 kindergarten students for untreated decayed primary teeth (dt) as part of the statewide public health surveillance system. The authors aggregated observations to the school level and matched 7,660 school-year observations for 1,215 schools to National School Lunch Program (NSLP) participation rates, their primary economic indicator of the Great Recession. The authors included additional county-level economic indicators and measures of dentist supply and Medicaid enrollment. They used ordinary least squares regression with school-and year-fixed effects to examine the association of variables with the proportion of children with more than one dt for all schools and for schools with a greater than 10 percent increase in NSLP participation after 2006.
  
  
  RESULTS
  The authors found a small but statistically significant association between the proportion of children in the schools participating in the NSLP and the proportion of kindergarten students who had more than one dt (β, 0.031; 95 percent confidence interval [CI], 0.001 to 0.0604). This association was greater in schools that had a greater than 10 percent increase in NSLP participation (β, 0.068; 95 percent CI, -0.007 to 0.143). Regression estimates indicate a 1.3- and 3.1-percentage point cumulative increase in the proportion of children with more than one dt during the period from 2008 through 2009 for all schools and high-risk schools, respectively.
  
  
  CONCLUSIONS
  Increased NSLP enrollment was associated with less treatment for dental caries in 5-year-old children.
  
  
  CONCLUSIONS
  Fewer children are receiving needed dental treatment because of the Great Recession. Recent gains made in the treatment of dental caries in children in NC have slowed as a result.
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Rania
authors.initials: R
authors.lastname: Abasaeed
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Kranz
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
mesh_terms: D002675:Child, Preschool; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D003815:Dentists / Q000600:supply & distribution; D057172:Economic Recession / Q000706:statistics & numerical data*; D063105:Food Assistance / Q000706:statistics & numerical data; D005522:Food Services / Q000706:statistics & numerical data; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance; D011203:Poverty / Q000706:statistics & numerical data; D012574:Schools; D014094:Tooth, Deciduous / Q000473:pathology; D014481:United States / Q000453:epidemiology
keywords: Access to care; caries; dental care for children; dental care utilization; poverty