February 2012 Newsletter

A message from our Center

As the National Center for Ease of Use of Community-Based Services, we are committed to advancing policy and practice solutions that improve the ease of use of community-based services for families with a child with special health care needs (CSHCN). We hope that our newsletters will provide information that improves ease of use by connecting readers to new research and innovations, resources and successful programs. This February we cover oral health for children with special health care needs.

We've been busy and February has been an exciting month. We just got back from the Annual AMCHP Conference in Washington, DC. . It was a great opportunity to connect with so many of the people working hard each day to improve child health. If you missed us at AMCHP, feel free to check out the presentation slides which are available on our website.

We are excited to announce that our Center's Myra Rosen-Reynoso and Ngai Kwan will be presenting their research on children's preventive oral health disparities at the National Oral Health Conference (NOHC). Their presentation will be available on our website after the conference.

Thanks for reading, be on the look out for more newsletters in the future!   


All the Best,

The Staff at the National Center for Ease of Use

Oral Health and CSHCN

A young girl happy at the dentist

Why is Dental Care an issue for CSHCN?

Oral health is vital to the overall health of children. As former Surgeon General C. Everett Coop said, "You are not a healthy person unless you have good oral health. Oral health is part of general health and it can affect your overall health and your quality of life."    

  • Untreated oral health issues can cause severe chronic problems that are hard to cure.
  • According to the National Survey of Children with Special Health Care Needs, 81% of families of CSHCN reported that their children were in need of preventive dental care and about a quarter of parents also reported a need for other dental services.    

What puts CSHCN at risk for oral health problems?

CSHCN can have physical characteristics that put them at gre ater risk for oral health problems. They may be more prone to tooth clenching (bruxism), have abnormal oral development, and may experience oral trauma. Some medications that cause reduced saliva flow make it easier for bacteria that cause tooth decay to grow. Other medications that are high in sugar can cause cavities and other problems. Anti-epileptic medications may lead to gum problems.

CSHCN with compromised immune systems and certain cardiac conditions may be particularly at risk for oral disease. Others with mental, developmental, or physical impairments may not understand or have the ability to take care of their oral health care, and may need someone assist them.

What are the barriers to dental treatment for CSHCN?

The specific oral health needs of CSHCN can present a variety of challenges for providers, and these children face many systemic difficulties when trying to obtain dental care. They may be unable to find a provider who is knowledgeable about their needs and willing to give them care. Many dental practices do not accept Medicaid payments because of the long wait for reimbursement.

Oral health professionals may feel inexperienced and uncomfortable treating children with special needs. They may not have the capacity or training to sedate a child with general anesthesia. There is a national shortage of pediatric dentists, and even fewer who have experience working with CSHCN. Caregivers have to travel long distances to obtain dental care for their child, especially if they live in a rural area.         

How can our center address this issue?

  • Host webinars
  • Identify states that have made dental care a priority and encourage mentorship and partnership between states
  • Identify potential entry points where Title V programming can improve access to dental care for CSHCN
  • Compile resources on oral health for CSHCN

For more information on oral health, visit our web page on Oral Health Resources

Center Activities

In support of making oral health services easy to use for families with CSHCN the Center recently facilitated a webinar called Partnering to make oral health services easier to use for families with CYSHCN. Diane Flanagan of Child's Health Alliance of Wisconsin and Amy Whitehead of the Wisconsin CYSHCN Program presented on how statewide partnerships and collaborations in Wisconsin improved CYSHCN oral health. Feel free to view the archive, slides, and text from the presentation.  

Preventive Dental Care & CSHCN

Graph displaying visual representations of percentages; national average = 83.9%, Non-hispanic White=86.10%, Hispanics overall=77.5%, English Speaking Hispanics=82.8%, Non-English Speaking Hispanics=68.3%

The above graph shows the percentage of children with special care needs (CSHCN) who have seen a dentist for preventive care in the past 12 months. The data shows disparities between Hispanics overall and non-Hispanic whites. The data indicates greater disparities between English Speakers and non-English speakers in their access to oral health care.


Data Source: National Survey of Children's Health, 2007 

Interview with an expert

Ann Drum, DDS, MPH, has taken the time to share some expertise regarding oral health care for CSHCN populations. She serves as the chair of our center’s advisory committee. A little background on Dr. Drum--she spent majority of career as clinician, researcher and public health administrator. She served for many years on the national and regional levels from a public health administrative approach as training director of MCHB.

When addressing a group as diverse as CSHCN, how do you create inclusive oral health policy?

It's an interesting question because first of all oral health care is the most unmet need for all of CSHCN and really for all children. I think what makes CSHCN special in a way is it is a very diverse group with a variety of needs specific to oral health.
As a very diverse group, it does make it more complex from a policy perspective. CSHCN use more oral health services and yet they are less likely to get services. Health is everyone's responsibility and that's really true of oral health too, somehow we have to do better training professionals. All children need these preventative services and somehow that is getting lost in the system.

What kinds of disparities have you observed in CSHCN oral health care? How have you addressed them successfully?

CSHCN do not receive as many preventative services and there are many reasons for that. Sometimes people are so busy meeting all the child's needs it somehow gets left behind. Studies show that children in rural areas really don't receive the services they need, which is a problem is those communities.

The National Survey results show disparities in oral health care particularly between English speakers and non-English speakers.  What do these findings tell us about the needs and where policy/activity is needed?

For many non-English speakers that come to this country, their knowledge of oral health is much lower, for example they may not have had good access to oral health in their own country. We need to do a better job for these populations and make them aware of oral health's importance to overall health.For all children of non-English speaking populations, providing services in a very family-centered way is probably very important.    

What do you see as the main MCHB priorities for oral health at this time?

I am now retired but I know there is a lot of interest in looking at the integration of oral health and general health. They want to find out if providers from different sectors are working together to see that children and CSHCN families have access to health services. This includes preventative health services and doing everything in terms of their own home care.


Interview was condensed and edited.