With the introduction of the Affordable Care Act (ACA), lower-income children were granted equal access to dental care as their peers. However, they still don’t have the same level of oral health as privately insured children. According to the Centers for Disease Control, one in five children aged five to 11, have at least one untreated cavity. However, a more staggering fact is that “the percentage of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%).” What’s holding these children back from having similar oral health if both populations now have similar access?
No Access to Dental Care
Prior to the passage of the ACA, lower-income children did not have the same access to dental care as their peers, and because of that, they missed out on annual screenings or preventive care throughout their lives. Now that dental coverage is a requirement for children under the age of 19, all children have equal opportunity to focus on their oral care. In fact, the ADA Health Policy Resources Center projects that approximately 8.7 million children may gain extensive dental coverage by 2018 through the implementation of the ACA.
However, the passage of the ACA was only a few years ago, which means lower-income children need time to catch up to their higher-income peers. Children with private insurance have most likely been seeing their dentist twice a year throughout their lives, and they understand the importance of proper oral health. Lower-income children are still adjusting to making dental care a priority. Their first appointment may have focused on issues they were experiencing, such as cavities or infections. There may be prior problems that need addressing before education and preventive care can truly begin.
Also, there’s a demographic that may be covered by dental insurance, but are simply unable to make an appointment or get to the office. These children may not have a parent willing to advocate for their oral health. Practices could be located in an area the child is not able to access with public transportation. Plus, not all dentists accept the dental insurance plans that cover this population. Similarly, while lower-income children are gaining access to dental insurance and beginning to seek treatment by dentists, cost is still a prohibitive factor in purchasing new toothpastes and toothbrushes, simple products necessary for maintaining and preventing dental-health issues.
Poor Nutrition Choices
Food choice has always played a significant role in oral health, with increased sugar intake contributing to the development of cavities. Families who are dependent on food pantries often do not have control over the nutrition available to their children. They take what they get, which is often filled with sugar and preservatives. Also, households that rely on government assistance need to purchase the most cost-effective food selections, often loaded with sugars. It isn’t just food quantity that lower-income families have to worry about: it’s food quality. Without access to healthy options, children are forced to consume what’s available to them. Since many school-aged, lower-income children eat breakfast and lunch at school with subsidized or free food programs, the education departments need to reform meal plans to provide nutritional choices to all students.
Limited Family Education About Oral Wellness
Positive oral care starts when a child is only a baby. The American Dental Association recommends the brushing of teeth twice a day, but if no one does so for a child, how will they learn to take on this responsibility themselves as they age? Dental education needs to begin at an early age, which is why pediatricians and schools should work with dentists to discuss the importance of maintaining oral health. Dental care starts in the home, so lower-income parents also need counseling on ways to teach their children to brush, floss and use mouthwash. Finally, children learn by example, so their parents and older siblings also need to follow a regular teeth-cleaning routine. While adults don’t have the same opportunities for dental coverage under the ACA, they should still take care of their teeth to inspire their children.
If the ADA Health Policy Resources Center’s projections are correct, more children are set to be covered by dental insurance in the next two years, giving lower-income children a better opportunity to catch up to their privately insured peers.