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Child Oral Health and Dental Service Access Among Children with Intellectual Disabilities, Autism, and Other Educational Additional Support Needs: A Population-Based Record Linkage Cohort Study
20 Pages Posted: 2 Mar 2022
More...Abstract
Background: Inequalities in child oral health is a global challenge and the intersection of socioeconomic factors with educational additional support needs (ASN), including children with intellectual disabilities(ID) or autism, has thus far received limited attention. We aimed to investigate the oral health and dental service access among children with ASN compared to the general child population.
Methods: Cohort study linking data from four Scotland-wide health and education databases compared dental caries experience, receipt of school-based dental inspection, access to primary care and hospital dental services, and access to the Childsmile national oral health improvement programme among children with ASN to their peers for the school years 2016/17-2018/19 (n=166 781).
Findings: Children with any ASN had higher rates of caries experience than those with no ASN, however after adjustment only those with a social or other ASN remained at increased risk. Tooth extraction under general anaesthesia in hospital was increased among children with ID (aRR=1.67;95%CI=[1.16,2.37]). School-based dental inspection access has improved for children with ID or autism from 2016/17, although higher rates of child refusal were observed in these groups (no ASN refusal:5.4%; ID:35.8%; autism:40.3%). Children with any ASN were less likely to attend primary dental-care regularly, and in those who attended, children with ID or autism were less likely than their peers to receive prevention (fluoride varnish, oral-hygiene instruction, or diet advice). Childsmile nursery-supervised toothbrushing programme access among children with any ASN was similar to children with no ASN, and children with ID (aRR=1.27;95%CI=[1.12,1.45]) or autism (aRR=1.32;95%CI=[1.19,1.45]) were more likely to receive Childsmile dental-health-support worker contacts.
Interpretation: There are clear inequalities in oral health and dental-care access for children with ASN, however they are accessing the Childsmile-programme in parts. Further efforts are needed to improve preventive care pathways and integrate oral health to wider healthcare systems for these vulnerable children.
Funding Information: Bailey Thomas Charitable Fund.
Declaration of Interests: All authors declare no competing interests.
Ethics Approval Statement: Ethical approval was obtained from the University of Glasgow Ethics Committee (Project number MVLS200150076). This study received approval from the NHS National Services Scotland Privacy Advisory Committee and Public Benefit and Privacy Panel - (PBPP) Approval no.1617-0302 Amendment Approval 2019 09 04.
Keywords: Child oral health, dental caries, dental service, intellectual disabilities, autism, educational additional support needs, cohort study, data linkage
Suggested Citation: Suggested Citation