title: Influence of caregivers and children's entry into the dental care system.
abstract: OBJECTIVE
  Early preventive dental visits are essential in improving children's oral health, especially young children at high risk for dental caries. However, there is scant information on how these children enter the dental care system. Our objectives were as follows: (1) to describe how a population-based cohort of young Medicaid-enrolled children entered dental care; and (2) to investigate the influence of caregiver characteristics on their children's dental care-seeking patterns.
  
  
  METHODS
  We relied on Medicaid claims and interview data of caregiver-child dyads who were enrolled in the Carolina Oral Health Literacy study during 2007-2008. The analytical cohort comprised 1000 children who had no dental visits before enrollment. Additional information was collected on sociodemographic characteristics, oral health status, health literacy, dental neglect, and access to care barriers. Our analyses relied on descriptive, bivariate, and multivariate methods.
  
  
  RESULTS
  During the 25-month median follow-up period, 39% of the children (mean baseline age: 16 months) entered the dental care system, and 13% of their first encounters were for emergency care. Caregivers' dental neglect emerged as a significant predictor of nonentrance. Children with reported oral health problems at baseline were more likely to enter the dental care system compared with children with better oral health, but they were also more likely to require emergency care.
  
  
  CONCLUSIONS
  Caregivers have a pivotal role in children's oral health and care. Interventions aimed at improving children's oral health should involve community outreach to engage caregivers in a culturally appropriate manner when their children are infants or toddlers.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, kimon_divaris@unc.edu.
authors.forename: Kimon
authors.initials: K
authors.lastname: Divaris
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, Department of Health Policy and Management, Gillings School of Global Public Health.
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry.
authors.forename: A Diane
authors.initials: AD
authors.lastname: Baker
authors.affiliation: Center for Health Promotion and Disease Prevention, and.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health.
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
authors.affiliation: Department of General Medicine and Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry.
authors.forename: William F
authors.initials: WF
authors.lastname: Vann
mesh_terms: D000328:Adult; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D015331:Cohort Studies; D019140:Dental Care for Children / Q000523:psychology*; D003731:Dental Caries / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D009657:North Carolina; D009911:Oral Hygiene Index; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011313:Preventive Dentistry; D014481:United States; D055815:Young Adult
keywords: caregivers; children; dental neglect; dentistry; health literacy; health services; health services use; literacy; oral health
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