According to estimates from the Children’s Bureau, an agency in the US Department of Health and Human Services, there were 673,000 children in foster care in the United States in 2019.
Data from the Minnesota Department of Human Services says about 15,300 children experienced foster care in 2019. Minnesotan children of color were overrepresented compared to the general population, with Native American children 18 times more likely and black children three times more likely to experience foster care than white children.
Most children in the foster care system have medical and dental coverage through Medicaid. However, despite mandatory state dental coverage, children in foster care face significant barriers to accessing oral health care. One of the biggest hurdles is finding a dentist who takes Medicaid or the Children’s Health Insurance Program.
A new study from the University of Minnesota published in The Journal of the American Dental Association compared self-reported oral health needs and access to dental care between youth who have and have not experienced foster care. The data was drawn from the 2019 Minnesota Survey of Students, a statewide survey of public school students in grades 5, 8, 9 and 11. Youth with a history of foster care were compared with youth without a history of foster care on seven indicators of oral health.
Young people were asked whether or not they had experienced five types of dental problems in the past 12 months:
- toothache or pain;
- decayed teeth or cavities.
- Swollen, painful or bleeding gums.
- I couldn’t eat certain foods because of a dental problem.
- Missed one or more school days due to a dental problem.
If youth reported any dental problem, they were asked if that health problem was treated by a dentist and when they last had a dental appointment for a checkup, examination, teeth cleaning, or other dental work. Finally, they were asked about usual dental care: when was the last time they saw a dentist for a check-up, examination or cleaning of teeth or other dental work.
“To our knowledge, this study is the first in the United States to survey youth with a history of foster care about their oral care needs using their own words,” said the study’s co-author. Elise W. Sarvas, clinical associate professor of pediatric dentistry at the U of M School of Dentistry. “We found that compared to their peers, youth with a history of foster care have self-identified dental needs, including problems with pain, and have less access to a dentist to address those needs.”
Specifically, the study showed that:
- Youth with a history of foster care were more likely to report each of the five dental problems and less likely to report receiving dental care, compared to their peers without a history of foster care.
- About 44% of youth with a history of foster care reported at least one dental problem, compared to 32.2% of youth with no foster care experience.
- Youth with a history of foster care were less likely than their peers to visit a dentist for a dental problem (58.2% vs. 71.2%) or for routine dental care (69.6% vs. 84.4%) no history of foster care.
“There are probably several reasons why youth with a history of foster care have more dental problems than their peers,” said co-author Rebecca J. Shlafer, assistant professor at the U of M Medical School. “Compared to their peers, foster youth in this sample were more likely to report living in households experiencing poverty. “Dentists should recognize the oral health concerns of this group of children in the context of their special health care needs and be prepared to provide appropriate care.”
Co-authors include; Judith K. Eckerle and Kimara L. Gustafson with the School of Medicine and Rebecca L. Freese with the Institute of Clinical and Translational Science in the Office of Academic Clinical Affairs.
Support for this study was provided by the National Institutes of Health’s National Center for Advancing Translational Sciences, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration.
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