The impact of universal access to dental care on disparities in caries experience in children

Background. The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had live d since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program. Methods. The authors selected a representative sample of first-grade childr en using a stratified multistage sampling method of primary schools (n = 1, 614). The response rate was 78.8 percent. Two dentists were trained to diag nose dental caries using modified World Health Organization criteria. Intra - and interexaminer reliability was excellent (kappa greater than or equal to 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Da ta were weighted and adjusted for clustering (design) effects. Results. Only 8.4 percent of the children had visited a dental office befor e the age of 2 years, and 88.5 percent of the children had their first dent al visit between the ages of 2 and 5 years. Children whose parents had comp leted a university education had a significantly lower mean number of decay ed, missing and filled surfaces, or dmfs, in their primary teeth than did c hildren whose parents had a lower education level. A Poisson regression mod el indicated that parents' high education status, optimal fluoride concentr ation in schools' water supplies, daily tooth-brushing and dental visits fo r checkup were significantly associated with low dmfs scores. Conclusions. Having access to a universal publicly financed dental insuranc e program since birth did not eliminate the disparities in caries experienc e. Practice Implications. This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused effor ts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.