Maternal and Child Health Journal

, Volume 22, Issue 5, pp 753–761 | Cite as

Dental Service Utilization Among Children in the Child Welfare System

  • Tracy L. Finlayson
  • Emmeline Chuang
  • Jong-Deuk Baek
  • Robert Seidman



To examine predisposing, enabling, and need-related factors associated with dental utilization by children involved with the child welfare system (CWS).


Data were analyzed from the National Survey of Child and Adolescent Well-Being (NSCAW; Wave II), a national probability sample of children (2–17 years) following a welfare assessment during 2008–2009 (n = 2806). Caregiver-reported child receipt of dental services in the past year was the outcome in weighted logistic regression models.


Two-thirds of children had a recent dental visit. Older children (OR 2.95, 95% CI 2.06,4.21 for ages 6–11; OR 2.47, CI 1.82, 3.37 for ages 12–17, compared to ages 2–5) were more likely to have visited the dentist, as were children of more educated caregivers (OR 1.68; CI 1.20, 2.36 for high school, OR 2.45; CI 1.71, 3.52 for more than high school). Children without a usual source of care (OR 0.50; CI 0.27, 0.94) and those living with non-biological parents had lower odds of a recent visit (OR 0.64; CI 0.43, 0.97). Children with dental problems were twice as likely to have a recent visit (OR 2.02; CI 1.21, 3.38), while children with unmet needs who could not afford care had lower odds of utilizing services (OR 0.28; CI 0.16, 0.46).

Conclusions for Practice

Many children in the CWS, especially younger children (ages 2–5), did not have a reported dental visit in the past year. Cost was a barrier, and caregiver status was associated with the likelihood of obtaining dental care. Health and social service providers should refer these children for dental care.


Oral health Utilization Children Child welfare 



The National Survey on Child and Adolescent Well-Being was developed under contract with the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services (ACYF/DHHS). The data have been provided by the National Data Archive on Child Abuse and Neglect. The information and opinions expressed herein reflect solely the position of the authors.


Funding was provided by National Institute on Drug Abuse (Grant No. R03 DA032863-01) to Dr. Chuang.


  1. Achenbach, T. M. (1991). Manual for the Child Behavior Checklist: 4–18 and 1991 Profile. Burlington, VT: University of Vermont Department of Psychiatry.Google Scholar
  2. Allen, K. (2010). Health screenings and assessment for children and youth entering foster care: state requirements and opportunities, Center for Health Care Strategies, Inc. Retrieved March 1, 2017 from
  3. American Academy of Pediatric Dentistry (2010). Definition of dental neglect. Pediatric Dentistry 25(suppl): 7.Google Scholar
  4. American Academy of Pediatric Dentistry, Clinical Affairs Committee (2013). Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Clinical Guidelines Reference Manual 35(6): 114–122.Google Scholar
  5. American Academy of Pediatrics. (2007). AAP strategic plan guides activities on behalf of children, members. AAP News, 28, 36.
  6. American Academy of Pediatrics. Policy on dental home. Retrieved from; 111/5/1113.
  7. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.CrossRefPubMedGoogle Scholar
  8. Beil, H., Mayer, M., & Rozier, R. G. (2009). Dental care utilization and expenditures in children with special healthcare needs. Journal of the American Dental Association, 140(9), 1147–1155.CrossRefPubMedGoogle Scholar
  9. Bhaskar, V., McGraw, K. A., & Divaris, K. (2014). The importance of preventive dental visits from a young age: systematic review and current perspectives. Clinical, Cosmetic and Investigational Dentistry, 6, 21–27.PubMedPubMedCentralGoogle Scholar
  10. Casamassimo, P. S., Thikkurissy, S., Edelstein, B. L., & Maiorini, E. (2009). Beyond the dmft: The human and economic cost of early childhood caries. The Journal of the American Dental Association, 140(6), 650–657.CrossRefPubMedGoogle Scholar
  11. Center for Health Care Strategies. (2013). Making medicaid work for children in child welfare: Examples from the field. Retrieved March 1, 2017 from
  12. Chi, D. L., Momany, E. T., Jones, M. P., Kuthy, R. A., Askelson, N. M., Wehby, G. L., & Damiano, P. C. (2013). Relationship between medical well baby visits and first dental examinations for young children in Medicaid. American Journal of Public Health, 103(2), 347–354.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Combs-Orme, T., Chernoff, R. G., & Kager, V. A. (1991). Utilization of health care by foster children: Application of a theoretical model. Children and Youth Services Review, 13(1-2), 113–129.CrossRefGoogle Scholar
  14. Dale, G. Jr., Kendall, J. C., & Schultz, J. S. (1999). A proposal for universal medical and mental health screenings for children entering foster care. In G. D. J. P. A. Curtis, J. C. Kendall & J. D. Rockefeller IV. (Ed.), The foster care crisis: Translating research into policy and practice (pp. 175–192). Lincoln: University of Nebraska Press.Google Scholar
  15. DeLeeuw, J., & Meijer, E. (2008). Handbook of multilevel analysis. New York: Springer.Google Scholar
  16. DePanfilis, D. (2006). Child neglect: A guide for prevention, assessment, and intervention. Washington DC: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Office on Child Abuse and Neglect.Google Scholar
  17. Divaris, K., Lee, J. Y., Baker, A. D., Gizlice, Z., Rozier, R. G., DeWalt, D. A., & Vann, W. F. (2014). Influence of caregivers and children’s entry into the dental care system. Pediatrics, 133(5), e1268-e1276.CrossRefPubMedCentralGoogle Scholar
  18. Dowd, K., Dolan, M., Wallin, J., Miller, K., Biemer, P., Aragon-Logan, E., et. al (2010). National survey of child and adolescent well-being II: Data file user’s manual restricted release version. Ithaca, NY: National Data Archive on Child Abuse and Neglect.Google Scholar
  19. Fortin, K. (2010). Caring for foster children. In C. Jenny (Ed.), Child abuse and neglect diagnosis, treatment, and evidence (pp. 610–614). St Louis: Elsevier Saunders.Google Scholar
  20. Griffin, S. O., Barker, L. K., Wei, L., Li, C., Albuquerque, M. S., & Gooch, B. F. (2014). Use of dental care and effective preventive services in preventing tooth decay among U.S. children and adolescents—Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. MMWR, 63(2), 54–60.Google Scholar
  21. Hakim, R. B., Babish, J. D., & Davis, A. C. (2012). State of dental care among Medicaid-enrolled children in the United States. Pediatrics, 130(1), 1–10.CrossRefGoogle Scholar
  22. Health, U. S. (2015). Dental visits in the last year, by selected characteristics: United States, selected years 1997–2014. National Center for Health Statistics. Retrieved March 1, 2017 from
  23. Horwitz, S. M., Hurlburt, M. S., Goldhaber-Fiebert, J. D., Heneghan, A. M., Zhang, J., Rolls-Reutz, J., et al. (2012). Mental health services use by children investigated by child welfare agencies. Pediatrics, 130(5), 861–869.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Isong, I. A., Soobader, M.-J., Fisher-Owens, S. A., Weintraub, J. A., Gansky, S. A., Platt, L. J., & Newacheck, P. W. (2012). Racial disparity trends in children’s dental visits: US National Health Interview Survey, 1964–2010. Pediatrics, 130(2), 306–314.CrossRefGoogle Scholar
  25. Kortenkamp, K., & Macomber Ehrle, J. (2002). The well-being of children involved with the child welfare system: A national overview. Washington, DC: The Urban Institute Series B.Google Scholar
  26. Landsverk, J. A., Garland, A. F., & Leslie, L. K. (2002). Mental health services for children reported to child protective services. In J. E. Myers, L. Berliner, J. Briere, et al. (Eds.), APSAC handbook on child maltreatment (pp. 487–507). Thousand Oaks, CA: Sage.Google Scholar
  27. Leslie, L. K., Sigrid, J., Monn, A., Kauten, M. C., Zhang, J., & Aarons, G. (2010). Health-risk behaviors in young adolescents in the child welfare system. Journal of Adolescent Health, 47(1), 26–34.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Leve, L. D., Harold, G. T., Chamberlain, P., Landsverk, J. A., Fisher, P. A., & Vostanis, P. (2012). Practitioner review: Children in foster care—vulnerabilities and evidence-based interventions that promote resilience processes. Journal of Child Psychology and Psychiatry, 53(12), 1197–1211.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Lewis, C. W., Grossman, D. C., Domoto, P. K., & Deyo, R. A. (2000). The role of the pediatrician in the oral health of children: A national survey. Pediatrics, 106(6), 84–90.CrossRefGoogle Scholar
  30. McCrae, J. S., & Barth, R. (2008). Using cumulative risk to screen for mental health problems in child welfare. Research of Social Work Practice, 18, 144–159.CrossRefGoogle Scholar
  31. Melbye, M., Huebner, C. E., Chi, D. L., Hinderberger, H., & Milgrom, P. (2013). A first look: Determinants of dental care for children in foster care. Special Care in Dentistry, 33(1), 13–19.CrossRefPubMedGoogle Scholar
  32. Mersky, J., Berger, L., Reynolds, A., & Gromoske, A. (2009). Risk factors for child and adolescent maltreatment: A longitudinal investigation of a cohort of inner-city youth. Child Maltreatment, 14(1), 73–88.CrossRefPubMedGoogle Scholar
  33. Mouradian, W. E., Lewis, C. W., & Berg, J. H. (2014). Integration of dentistry and medicine and the dentist of the future: The need fo rthe healthcare team. Journal of the California Dental Association, 42(10), 687–696.PubMedGoogle Scholar
  34. Ringeisen, H., Casanueva, C. E., Urato, M. P., & Cross, T. P. (2008). Special health care needs among children in child welfare. Pediatrics, 122(1), 232–241.CrossRefGoogle Scholar
  35. Romaire, M. A., Bell, J. F., & Huebner, C. E. (2012). Variations in children’s dental service use based on four national health surveys. Pediatrics, 130(5), e1182-e1189.CrossRefGoogle Scholar
  36. Savage, M. F., Lee, J. Y., Kotch, J. B., & Vann, W. F. Jr. (2004). Early preventive dental visits: Effects on subsequent utilization and costs. Pediatrics, 114(4), e418-423.CrossRefGoogle Scholar
  37. Section on Pediatric Dentistry and Oral Health. (2008). Preventive oral health intervention for pediatricians. Pediatrics, 122(6), 1387–1394.CrossRefGoogle Scholar
  38. U.S. Department of Health and Human Services. (2013). Health Resources and Services Administration, Maternal and Child Health Bureau. Administration for Children and Families, Administration on Children, Youth, and Families, Children’s Bureau. Child maltreatment 2012. Retrieved March 1, 2017 from
  39. U.S. Government Accountability Office. (2010). Oral health: Efforts under way to improve children’s access to dental services, but sustained attention needed to address ongoing concerns: Report to Congressional Committees. Washington, DC: U.S. Government Accountability Office.Google Scholar
  40. Vujicic, M., & Nasseh, K. (2014). A decade in dental care utilization among adults and children (2001–2010). Health Services Research, 49(2), 460–480.CrossRefPubMedGoogle Scholar
  41. Welbury, R. (2016). Dental neglect, child maltreatment, and the role of the dental profession. Contemporary Clinical Dentistry, 7(3), 285–286.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tracy L. Finlayson
    • 1
  • Emmeline Chuang
    • 2
  • Jong-Deuk Baek
    • 1
  • Robert Seidman
    • 1
  1. 1.Health Management & Policy, Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  2. 2.Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesUSA

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