BACKGROUND: Oral health plays a critical role in health and well-being along the life span. Poor oral health has impacts on both a physical and psychological level including infections, ability to eat, social interactions, self-confidence and is associated with increased hospitalizations and emergency department visits, poor school performance, and other adverse outcomes. Early childhood caries is highly preventable with good oral hygiene, diet, fluoride exposure and regular dental visits. The objective of the study was to determine if urgent need for dental treatment among third grade children in Hawaii varied by race, socio-economic factors, and receipt of dental sealants.
METHODS: The Hawaii Basic Screening Survey (BSS) is a clinical assessment of public school children in third grade that is weighted to provide state estimates. The Hawaii BSS was linked to Department of Education records to collect race and free or reduced lunch status. Data from the 2015 Hawaii BSS were analyzed for 3,184 child participants. Urgent dental treatment was a clinical determination by the health professional doing the screening. Multivariate logistic regression analysis assessed the need for urgent dental treatment in relation to race and participation in free or reduced lunch with adjustment for sex, age, and presence of at least one dental sealant on permanent first molars.
RESULTS: An estimated 7.2% of third grade children needed urgent dental treatment. Micronesian (Adjusted Odds Ratio (AOR)=7.8;95%CI=3.7-16.2), Other Pacific Islander (AOR=6.4;95%CI=2.5-16.4), and Filipino (AOR=2.5;95%CI=1.4-4.3) children were more likely to need urgent dental treatment compared with white children. Children that participated in free or reduced lunch programs were more likely (AOR=3.4;95% CI=2.0-5.9) to need urgent dental treatment compared with those that did not participate. Additionally, those without dental sealants were more likely (AOR=8.2;95%CI=3.9-17.3) to need urgent dental treatment compared with those with dental sealants.
CONCLUSIONS: About 7% of third grade public school children in Hawaii were identified as needing urgent dental treatment, substantially higher than the national average of <1%. Children needing urgent dental treatment were referred to providers and received follow-up by nurses and represents a significant financial burden to families, the health system and the state that could be prevented through regular dental care and good oral hygiene. Increasing awareness of this burden and understanding why differences exists can help inform program efforts. The department supports community based prevention programs, screening and referral services, and restorative dental care to those in need as three broad fundamental strategies to improve oral health of children in Hawaii.