Kids with medical complexity have poor oral health

A study presented at PAS 2024 shows that children with medical complexity (CMC) have poor oral health compared with children with special health care needs (CSHCN).

“CSHCN have worse oral health outcomes than children without special health care needs, despite increased preventive oral health service use,” noted presenting author Assistant Professor Kristina Malik from the University of Colorado School of Medicine, Aurora, Colorado, US.

“CMC, a subgroup of CSHCN with the most serious medical conditions resulting in functional limitations, may be at even higher risk for oral health diseases, but their oral health status is not well characterized,” added Malik and colleagues.

“[In our study,] CMC were twice as likely than CSHCN to have fair/poor teeth conditions. This remained significant after adjusting for socioeconomic factors that influence oral health despite similar access to preventive dental care,” the investigators said.

The weighted percentage of CSHCN with fair/poor teeth condition was 9.3 percent, whereas for CMC, the corresponding percentage was 18.7 percent. A between-group comparison yielded an adjusted odds ratio (adjOR) of 1.5 (95 percent confidence interval, 1.0–2.3; p<0.05). [PAS 2024, poster 272]

“This disparity could reflect factors unique to CMC that impact oral health such as behavioural and physical limitations to oral care, exposure to polypharmacy, or prioritization of multiple care needs,” the investigators explained.

The OR was adjusted for factors such as the child’s age, gender, race/ethnicity, insurance type, caregiver education and employment status, language the survey was taken in, caregiver physical and mental health, family structure, and medical home status.

Moreover, 20.2 percent of participants in the CMC group had cavities, as opposed to 15.6 percent in the CSHCN group (adjOR, 1.0). Albeit lacking statistical significance, the finding in the CMC group implies that one in five CMC have poor oral health, the investigators noted.

The CMC group also had more participants who reported having toothaches than the CSHCN group (8.4 percent vs 5.3 percent; adjOR, 1.2).

Apart from the significant disparity in the fractions of participants who received fluoride treatment (p=0.04), both treatment arms had similar proportions of patients receiving preventive dental services such as checkups, prophylaxis, radiographic examinations, sealants, and instructions on oral health care. Less than 10 percent of the overall cohort had unmet dental needs.

To compare the oral health status between CMC and CSHCN, the investigators used a nationally representative sample comprising 16,178 participants. Of these, 15,209 were CSHCN while 969 were CMC. About half of the participants were 12–17 years, while over a third were 6–11 years. Nearly two-thirds of the overall cohort were male.

However, as the study established prevalence by caregiver report, it may not be completely representative of clinical prevalence, the investigators noted. “This study could not capture if care provided was adequate, or if children received care at the recommended frequency,” they added.

Clinical implications

Nonetheless, the results underpin increased educational opportunities for paediatricians and dental health practitioners on unique factors that influence oral health of CMC, the investigators said. “CMC have unique factors impacting oral health, such as physical limitations, concurrent care needs, anatomical abnormalities, and altered salivary function.”

The findings also provide improved understanding of the systemic effects of poor oral health. These could also help identify potentially modifiable targets specific to CMC to improve their oral health status and potentially reduce the detrimental effects on their overall health, they continued.

The results also highlight the importance of medical-dental collaborations for CMC and assist clinicians and caregivers in care prioritization, they added.